ABSTRACT
The study evaluated the effects of UNICEF-Assisted Nutrition and Health Programme for rural women and children in South-East geo-political zone of Nigeria. The study determined among others, level of participation of women in the programme, nutritional status of the U5 children and the effectiveness of the programme in meeting set targets. Purposive and multi-stage random sampling techniques were employed in the selection of the sample size of two hundred and eighty-eight (288) participants from three out of the five states in the Zone (namely; Abia, Ebonyi and Enugu states) for the study. Structured questionnaire were used to elicit relevant information from the participants. The data collected were analyzed using mean scores, Body Mass Index (BMI), Mid Upper Arm Circumference (MUAC), Correlation coefficient, Analysis of variance (ANOVA) and Ordinary Least Squares regression (OLS). Results showed that the perception of the women participants of the programme was positive in nutrition package ( =3.13). On a 4point scale, it was nutrition informative. The level of participation of the women in the programme activities was high ( =3.16). The nutritional status of the U5 children participants showed that they were well nourished (15.34cm MUAC). It was revealed that there were positive behavioural changes in the women participants ( =3.17), the women sleeping under insecticide treated bed nets everyday with their children ( =3.59) and making of dietary plans for their families daily ( =3.19). The result also showed that the programme activities were effective and beneficial to the participants ( =2.23) on a benchmark of 2.00. The constraints affected the participants’ effective participation in the programme activities. The constraints included lack of awareness of the programme and its activities ( =3.38) and inadequate health and nutrition personnel ( =3.22) among others. The t-test of correlation coefficient of significant relationship indicated that there was a positive significant relationship between the rural women’s nutrition perception of the programme activities and their level of participation at 5% alpha level. The OLS regression estimate shows that the participation of U5 children in UNICEF-Assisted nutrition and health programme activities had significant effect on their nutritional status at 5% alpha level. The ANOVA test using DNMRT shows that there was a significant difference in the mean level of change in behaviour among the women participants of the programme in South-east states at 5% alpha level. The ANOVA test using DNMRT shows that there was significant difference in the perceived effectiveness of UNICEF-Assisted nutrition and health programme activities across the South-east states at 5% alpha level. The OLS regression estimate of relationship between constraints to effective participation of women and children U5 in the UNICEF-Assisted nutrition and health programme activities and their participation was significant and positively related at 5% alpha level. The study concluded that the programme was effective. It was therefore recommended that more efforts be made by donor agencies at improving women’s BMI (nutritional status).
TABLE
OF CONTENTS
Title page i
Declaration ii
Certification iii
Dedication iv
Acknowledgement v
Table of Contents vii
List of Tables xii
List of Figures xiv
Abstract xv
CHAPTER 1: INTRODUCTION
1.1
Background of the Study 1
1.2 Statement of the Problem 8
1.3 Research Questions 11
1.4 Objectives of the Study 11
1.5 Hypotheses 12
1.6 Significance of the Study 13
1.7 Scope of the Study 15
1.8 Limitations of the Study 15
1.9 Definition of Terms 16
CHAPTER 2: LITERATURE REVIEW 18
2.1 Meaning
of Evaluation 21
2.2 Types
of evaluation 21
2.2.1 Process
evaluation 22
2.2.2 Outcome
evaluation 22
2.2.3 Impact
evaluation 22
2.2.4 Summative
evaluation 23
2.3 Purpose of Evaluation 23
2.4 Evaluation Models 24
2.4.1 Expert
model 24
2.4.2 Naturalistic model 24
2.4.3 Management Decision model 25
2.4.4 Goal free model 25
2.4.5 Attainment by objectives
model 25
2.4.6 Experimental model 25
2.4.7 Participatory model 25
2.5 Elements of Evaluation 26
2.6 Evaluation Criteria 27
2.7 Meaning of Nutrition 28
2.7.1 Human nutrition 35
2.7.2 Nutrition intervention 35
2.7.3 Nutrition education 35
2.7.4 Nutrition intervention for
nutrition education 36
2.7.5 Nutrition sensitive
investment in Nigeria schools 36
2.8 Rural Nutrition in Nigeria 39
2.8.1 Nutrition and early child
brain development 41
2.8.2 Role of nutrition in rural
and national development 43
2.9 Malnutrition 44
2.9.1 Socio-economic impacts of
malnutrition 47
2.10 Socio-Economic
Characteristics of Rural Women in South-East Nigeria 49
2.11 Organizations Involved in
Nutrition Programmes in Nigeria 50
2.12 UNICEF Activities and its
Nutrition-Assisted Programmes in Nigeria 52
2.13 Implementation Pattern of
UNICEF-Assisted Nutrition Programme activities 55
2.13.1 Implementation activities 56
2.13.2 Special Programme activities 59
2.14 Nutrition and Sustainable
Development Goals (SDGs) Attainment 59
2.14.1 Nutrition and accelerated
sustainable development goals (SDGs) attainment 61
2.15 Theoretical Background 65
2.15.1 Basic needs theory 66
2.15.2 Positive feedback system
theory of poverty 68
2.16 Conceptual Framework 68
CHAPTER 3: MATERIALS AND METHODS
3.1 Area of Study 73
3.2 Population of the study 78
3.3 Sample and Sampling
Procedure 78
3.4 Data Collection 80
3.5 Validity of Instrument 80
3.6 Test of Reliability 80
3.7 Measurement of Variables 81
3.8 Data Analysis 83
3.9 Model Specification 85
CHAPTER 4: RESULTS AND DISCUSSION
4.1 Women Participants’
Perceptions of UNICEF-Assisted Nutrition Programme
Activities 96
4.2 Women Participants’
Perceptions of effect of UNICEF-Assisted Programme
Activities on Health 98
4.3 Level of Participation of
the Women Participants’ in the UNICEF-Assisted
Nutrition and health Programme activities 100
4.4 Level of Participation of
the U5 Children Participants’ in the UNICEF-Assisted
Nutrition and
Health Programme Activities 102
4.5 Nutritional Status of the
Women Participants of UNICEF-Assisted
Nutrition and
Health Programme Activities 104
4.6 Nutritional
Status of the U5 Children Participants of UNICEF-Assisted
Nutrition
and Health Programme Activities 105
4.7 Behavioural Changes in the
Women Participants as a Result of their
Participation in
the Programme Activities 105
4.8 Perceived Effectiveness of
UNICEF-Assisted Nutrition and Health Programme
in the Study Area 109
4.9 Constraints to Effective
Participation of Women and Children U5 in the
UNICEF-Assisted
Programme Activities 111
4.10 Hypotheses Testing 114
CHAPTER 5: SUMMARY, CONCLUSION AND
RECOMENDATIONS
5.1 Summary 130
5.2 Conclusions 134
5.3 Recommendations 135
References 136
Appendices 146
LIST
OF TABLES
4.1: Women
participants’ perception of UNICEF-Assisted Nutrition
programme
activities
97
4.2: Women
participants’ perceptions of effect of UNICEF-Assisted
Nutrition programme
activities on health 100
4.3: Level of participation of the Women participants in the
activities of UNICEF-Assisted
nutrition and health programme 102
4.4: Level of participation of the U5 children participants in the
activities of
UNICEF-Assisted nutrition and health programme 103
4.5: Nutritional status of Women participants in the study area 104
4.6: Nutritional status of U5 Children participants in the study
area 105
4.7: Behavioural changes in the Women participants that resulted
from
their participation in
UNICEF-Assisted nutrition and health programme 108
4.8: Perceived Effectiveness of UNICEF-Assisted
nutrition and health programme
in the study area 111
4.9: Constraints to effective participation of Women and Children U5
in the
UNICEF-Assisted nutrition programme
activities in the study area 114
4.10: PPMC coefficient of the relationship
between nutrition perceptions of
Women participants of
UNICEF-Assisted programme activities and their
participation 115
4.11: PPMC coefficient of the relationship between health perceptions
of Women Participants
of UNICEF-Assisted programme activities and their participation 116
4.12: OLS regression estimates of relationship between participation of
Women
in UNICEF-Assisted
nutrition and health programme on their BMI 118
4.13: OLS regression estimates of relationship between participation of
U5
Children in
UNICEF-Assisted nutrition and health programme on their
Nutritional status 122
4.14: ANOVA test using Duncan’s new multiple range test (DNMRT)
analysis of the
difference in the mean level of change in behaviour among
Women participants of
UNICEF-Assisted nutrition and health programme 124
4.15: ANOVA test using Duncan’s new multiple range test (DNMRT)
analysis of the mean
difference in the effectiveness of UNICEF-Assisted
nutrition and health
programme activities across the South-East states 125
4.16: OLS regression estimates of relationship
between the constraints to effective
participation of the women and
children U5 in the programme and their level
of participation 126
LIST
OF FIGURES
2.1: Maslow’s hierarchy of needs 66
2.2: Conceptual Framework of effectiveness of UNICEF-Assisted
nutrition and
health Programme for
rural Women and Children U5 in South-East, Nigeria 70
3.1: Map of the study area (South-East, Nigeria) 77
3.2: Configuration of the model for the sample frame 79
CHAPTER 1
INTRODUCTION
1.1 BACKGROUND
OF THE STUDY
Food
is any substance consumed to provide nutritional support for the body. It is
usually of animal or plant origin, and contains essential nutrients such as Carbohydrates,
Proteins, vitamins and minerals. The
substance is taken into the body and absorbed by the cells of the living thing
to produce strength, power, and ability to sustain life or encourage growth
(Davidson, 2006).
The
body uses nutrients for growth, maintenance and repair and needs to take in
about 40 varieties to function properly. Nutrients can be classified into six
groups:- carbohydrates, protein, fats, water, vitamins and minerals (Whitney
& Rolfes, 2013). These six nutrients are further classified according to
size and energy. Carbohydrate, protein and fat are macronutrients because they
make-up the bulk of an individual’s diet. Vitamins and minerals are in the
category of micronutrients due to the fact that they are required in much smaller
amounts. For example, an average human being is expected to consume about 2.5
gallons of water and food daily, but only one eighth of a teaspoon of that is
vitamins and minerals. This does not make vitamins and minerals useless. The
ignition key is only a small part of a car, but it’s hard to get the car
started without it. A deficiency in B12, which is just one of the eight B
vitamins, can result in anaemia, hypertensive skin, and degeneration of
peripheral nerves resulting in paralysis. Water is also a micronutrient because
it does not contain energy (Whitney & Rolfes, 2013).
Every human being goes through a repair process of replacing injured or
dead cells always notwithstanding if he or she is growing or not. However, food
provides the nutrients that are needed to facilitate the phases. It is food that provides the nutrients that
help to maintain the body's processes. Breathing in living things are
maintained by water, vitamins and minerals, even the nervous system’s functions,
digestion, blood circulation and the elimination of waste products from the
body. They help in the proper working of the body systems. Vitamins, minerals
and protein protect and keep the body's tissues and organs healthy. Healthy
organs are less likely to be attacked by disease (Eckel, et al., 2007).
Food security is often defined as access by all people at all times to
sufficient food required for a healthy and active life. Nutrition is not just
concerned with the abundant availability of food, but the availability of the
right ration of what to eat when needed (Fatman, 2009). In nutrition, there exists
the paradox that, while under nutrition leads to a serious set of health
problems, over-consumption of food and of certain dietary components is also
risky. It is widely accepted that most often, under nutrition in countries that
are developing could be due to inadequate intake of protein, energy and other
food nutrients (Singh and Raghuvanshi, 2012).
Food security is multifaceted and uses standardized measurement and policy
quite challenging for the policy makers. More so, food security entails “consistent,
dependable, access to, adequate food leading to active and healthy living (Alisha
Coleman-Jensen, et al, 2011).
Food insecurity is intrinsically unobservable and is typically defined as
the complement to food security. Food security is ordinarily formed resting on
three pillars of availability, access and utilization. Some agencies, like FAO,
posited that stability is the fourth side of food security. The pillars of food
security are nested, that is, food must be available for individuals to access it
and without access to food, individuals, cannot utilize food or rely on food as
a stable resource (Webb, et al.,
2006; Barret, 2010).
The most common cause of food insecurity is chronic on regular poverty,
not catastrophic events, such as earthquakes, floods or war that disrupts food
production and distribution at scale, although these events can result in
episodes of severe food insecurity (Barret, 2010).
Food security does not depend only on availability of adequate food, but
also on sustainability or permanent access to food. Food security could be said
to exist when everyone, at any needed time, have physical and economic access
to sufficient, safe and nutritious food to meet their dietary needs and
preferences for an active and healthy life. Achieving food security and
nutritional welfare includes ensuring: a nutritionally adequate and safe food
supply both at the national and household level, a reasonable degree of
stability in the supply of food during the year and in all years, and access by
each household to sufficient food to meet the needs of all (Fatman, 2009).
Nutrition, also called nourishment, is the provision of important
nutrients needed to organisms and to cells, in the form of food to aid life
(Eckel, et al., 2007).Most common health challenges and diseases can be corrected
or prevented or salvaged using a healthy diet. The diet of a living thing is
what it eats, which is largely determined by the perceived palatability of
foods (Andrew, et al., 2009). In developed countries, the diseases of
malnutrition are most often associated with unbalanced food intake or over
consumption (William, et al., 2006). Malnutrition means to eat
inadequate, too much or imbalanced food or nutrients by an organism (World Health
Organisation, (WHO, 2013).
For all households to be food secured, they must have physical and
economic access to sufficient food. The different households must always have
the ability, the knowledge and the resources to produce or procure the foods
that it needs. Nutritionists also stress the need for the food to provide for
all nutritional requirements of the household members, i.e. a balanced diet
should provide all the needed quantities of energy, protein and micronutrients
(Fatman, 2009).
Considering their multiple roles, women are key players in overcoming
malnutrition. They carry out pertinent roles in family food security and
nutritional balance as producers of food, traditional knowledge keepers and
biodiversity preservers, food processors and also they provide for their different
families food. Women are universally responsible for food preparation for their
families and engaged in various stages and steps of processing the food
(Fatman, 2009).
In many cultures and countries in Sub-Saharan Africa (including Nigeria),
women have the main responsibility for the provision of food, if not by
producing it, then by earning income to purchase it. This applies to urban and
non-farming women, as well as women farmers, and is not limited to the large
percentage of female-headed households in the world. This gender division of
responsibilities is often recognized by development planners. False assumptions
about households as a unit can have detrimental effects on family nutrition and
food security (Fatman, 2009).
Presently, developing countries population amounts to a total of about
7.2 billion out of a global population of 7.6 billion. This shows that
developing countries had 97% of the global population (CIA World Fact Book,
2018). About more than half of this population are women and these women
produce over 50 percent of food supplies and 80 percent in Africa (SOFA Team
and Cheryl, 2011). Regardless of women’s economic contribution, most developing
country women have little access to and control over resources. If women farmers
had the same access to resources as men, the number of hungry people in the
world could be reduced by up to 150 million (Food and Agriculture Organisation
(FAO, 2011).
Furthermore, about 80 percent live in rural areas. Regardless of the
nature of the economic role of women, or where it is present, these activities
are important social and economic indicators. However, undernourishment occurs
when people (women and children) regularly consume less food than their minimum
caloric (energy) requirements. Under nutrition is the resultant effect of lack
of adequate food consumption. Under nutrition more generally refers to
insufficient dietary energy and protein intake although it can also include
deficiencies in vitamins and minerals, or micronutrients (United Nations
International Children Education Fund (UNICEF, 2012).
Pregnancy and childbirth are rendered more dangerous by dietary
insufficiencies caused by the inequitable distributions of food (FAO). They
posited that women’s health and nutritional status is important for both the
quality of their lives and the survival and healthy development of their
children. Because women’s health and nutrition is a life cycle issue,
interventions must attend to female malnutrition from adolescence through
pregnancy and lactation, continuing with promotion of children’s growth during
infancy, preschool, school age, and adolescence. Direct action to improve
women’s health and nutrition complement the struggle to achieve the long-term
goals of gender equity and women’s empowerment. One area of concern in health
and nutrition security is the prevalence of inappropriate caring practices,
which may adversely affect children’s proper growth and development (FAO, 2013).
Since the World Food Summit in 1996, there has been an enormous support
especially from Non-Governmental Organizations (NGOs) and other Civil Society
Organizations (CSOs), to recognize the right to food as a human right. NGOs and
CSOs, including people’s and peasant’s organizations, have recognized the
concept of food sovereignty as essential for food security (World Food
Programme (WFP, 2012).
When governments assembled in 2001 to ascertain their progress so far made
in relation to their commitments regarding World Food Summit (WFS), the NGOs
and CSOs agreed that: “Food sovereignty means that people everywhere has the
right to formulate their own agricultural, labour, fishing, and food and land
policies in line with their ecological, social, economical and cultural
situations. It more so mean that the people have right to food and its
production. This entails that people everywhere have the right to nutritious, safe and
culturally-appropriate food or food-producing resources, and even the ability
for sustainability of their lives and their societies” (WFP, 2012). Created in
December 1946 by the United Nations to provide assistance to European children
facing famine and disease after the Second World War, UNICEF expanded its
programmes to other countries, and in 1952, the executive board approved its
programme for sub-Saharan Africa for the first time (UNICEF, 2008). Like other
non-governmental organizations, UNICEF- Nigeria has made concerted efforts to
ensure the food security of children, pregnant women and breastfeeding mothers
(UNICEF, 2008).
To this effect, the Federal Ministry of Health revealed that Nigeria
launched its National policy on food and nutrition in 2002, with the overall
goal of improving the nutritional status of Nigerians. This policy set specific
targets which include reduction by 30% of severe and moderate malnutrition
among children under-five years by 2010, and the reduction of micronutrient
deficiencies (principally of vitamin A, iodine and iron) by 50% by 2010 (FMOH, 2008).
UNICEF-Nigeria country programme 2002-2008 has Children at the heart of
the Millennium Development Goals. UNICEF has progressively moved from
assistance of specific “micro projects” to strengthening of human and
institutional capacities at the local level with a special focus on children,
adolescents and women. Consequently, as regards the development of
decentralized capacities, UNICEF Nigeria UNICEF “A” Field Enugu Nigeria
initiated and implemented nutrition programme for rural women and children in
the South-east states of Nigeria in 2002 with the overall objective of contributing
to the reduction of under-five child mortality rate (U5CMR) and improving
maternal health. The specific objectives of the programme included: to reduce
the incidence of malnutrition among infants and under-5 children and anaemia in
pregnant women in South-east Nigeria, to increase coverage with micronutrients
(iron, foliate, vitamin A, iodine, zinc) intake in pregnancy, lactation and
under-fives and thus reduce prevalence/consequences of their deficiency, to
increase exclusive breastfeeding rate, to promote key household health
practices (KHHP) in the communities; and to promote dietary diversification in
the South-east Nigeria (UNICEF, 2008). To achieve this, UNICEF held regional
level orientation for Nutrition Desk Officers in the states’ of the region.
These state Nutrition Desk Officers were saddled with the responsibility to
organise and train the Nutrition Officers at their local government areas.
Following the orientation, the desk officers are responsible and in return,
recruit and orientate rural support groups (RSGs) of at least 10 members (women
and men) in a group, selected from each ward in the L.G.As, who are resident
there. The rural support group members are people who command influence in the
community where they are resident. They are trained and retrained if need be to
aid them discharge their duties skillfully. At training, RSG members are
equipped with the skills and materials like fliers, training manual and books
(Civil Society-Scaling up Nutrition in Nigeria, (CS-SUNN, 2016). The rural
support groups go house to house sensitizing and educating women, fathers,
mothers and pregnant women on the intervention packages, exclusive breastfeeding
and its benefits, and other nutrition related issues associated with pregnancy,
which seeks to improve maternal health, child health and reduce mortality
(UNICEF, et al., 2011).
The packages of the intervention include; integrated maternal newborn and
child health strategy (IMNCHS), infant and young child feeding (IYCF), severe
acute malnutrition (SAM), integrated community case management (ICCM), expanded
programme on immunization (EPI), polio eradication initiative (PEI), (National
Primary Health Care Development Agency (NPHCDA, 2012). While, these programmes
activities include: micro nutrients (iron, foliate, vitamin A, iodine, zinc)
intake in pregnancy, during lactation, and under-fives, immunization,
de-worming, the use of long lasting insecticide treated bed nets (LLIN) for
malaria prevention, anti-malaria drugs, vaccinations against the killer
diseases, (measles, oral polio and tetanus oxide for women of child bearing age
and pregnant women), child care practices which include;- exclusive
breastfeeding (from 0 to 6 months), complementary feeding (6 to 18 months),
appropriate complementary feeding, supplementary feeding (18 to 24 months), key
household health practices (KHHP), which has clean water, hand washing,
personal hygiene and environmental cleanliness as components, also dietary
diversification and the use of community or household gardening. Others are,
care for pregnant women, treatment of patients and delivery by skilled birth
attendants, education of the girl child, nutrition health talks and training
sessions, etc (UNICEF, et al., 2011).
This is in line with its aim of consolidating on the perceived achievements of
the Millennium Development Goals (MDGs) 4 and 5 in the Sustainable Development
Goals (SDGs).
1.2 STATEMENT
OF THE PROBLEM
Globally, around
191 million children under-five appear stunted or wasted that is to say that
they are too short or too thin. Another 38 million of the under-fives were
overweight. However, obesity has become a global pandemic on its own as many
people are obese (FAO, IFAD, UNICEF, WFP and WHO, 2020).
Of all the regions
of the world, Africa remains the hardest hit with 19.1% of its people
malnourished. Taking cognizance of the current trends, by 2030, Africa will be
home to more than half of the world’s chronically hungry people (FAO, et al., 2020).
Nigeria has the
second highest malnutrition and nutrition related diseases in the world with
(37%) of her children under the age of five grouped as stunted and (19%) severely
stunted. More so, effects of micronutrients which may not be visible to the
ordinary eye are gradually felt all through the nation havingiodine, folic
acid, iron, zinc and Vitamin A as the most common (National Strategic Plan
Action for Nutrition(NSPAN, 2019). Worldwide, about 7 million children who are under
the age of five die every year. Under nutrition which is the number one cause
of morbidity for all age groups accounts for about 35% of these deaths among
children, and is also responsible for 11% of the disease burden. For maternal
mortality, iron deficiency is the leading cause, contributing 20% of the
estimated 536,000 deaths globally. In Nigeria, about 14 million people (8.5%)
of the total population are undernourished (NSPAN, 2014).
Nigeria has 29% of her children under the age of five underweight and
about 63% of her women are anaemic. As 31% of her women are iodine deficient,
close to 30% are vitamin A deficient (VAD), while 20% are zinc deficient. However,
only 17% of the children are exclusively breastfed (National Demographic Health
Survey (NDHS, 2013). This notwithstanding, the progress made in reducing
maternal mortality ratio has been slow. According to NDHS report of 2008 and
2013, Nigeria achieved practically no reduction in maternal mortality rate
(MMR). The index of maternal mortality rate for Nigeria is presently estimated
at 814 deaths per 100,000 live births and under five (U5) mortality rate at 70
per 1000 live births and infant mortality rate at 67 deaths per 1000 live
births (NDHS, 2018). This makes Nigeria the fourth largest contributor to
maternal mortality rate and the eight in under-five child mortality rate ranking
in the world (CIA World Fact Book, 2018).
There has been consensus among African leaders to spend 25 percent of
their national budgets on agriculture and food security. As at present, no
African country has committed such proportion of her funds to agriculture and
food security (Timothy, 2014). The River Basin Development Authority (RBDA),
Directorate for Food, Roads and Rural Infrastructures (DFRRI), Family Support
Programme (FSP), Family Economic Advancement Programme (FEAP), National Fadama
Development Programme (FADAMA), International Institute of Tropical Agriculture
(IITA), United Nations Children’s Emergency Fund (UNICEF) and conglomerates of
other governmental and non-governmental organizations were said to have made
concerted efforts towards the development of our rural areas via improvement in
food and nutrition at the household level, yet Nigeria reclines in malnutrition
and under nutrition (UNICEF, 2008).
Recently, all the agriculturally-related research institutes and state Agricultural
Development Programmes (ADPs) and other national and international
non-governmental organizations such as IITA, UNICEF, etc. have gender-specific
projects on food security and nutrition that have focus on women.
Notwithstanding the fact, that these programmes were targeted on women, hunger
and malnutrition among women and children still abound in various rural areas
of the nation (UNICEF, 2008).
The health-care that a mother receives during pregnancy and soon after
delivery is important for the survival of both the mother and her child
(UNICEF, 2006). Maternal mortality and under-five (U5) child mortality rates
are basic indicators of a country’s socio-economic status. Nigeria still
records high maternal and under-five child mortality rates among the nations of
the world, notwithstanding the perceived attainment of the MDGs targets (WHO,
UNICEF, UNFPA, and World Bank, 2015). The recent 2013 NDHS shows a decrease in
the mortality rates, the overall annual reduction rate is still slow thereby
putting Nigeria amongst group of countries within sufficient performance on the
MDG 4 and 5 as well as the potential for achieving the SDGs 2 - Zero hunger,
which seeks to end hunger, achieve food security and improved nutrition and
promote sustainable agriculture, and SDG 3 –Good health and well-being, ensure
healthy lives and promote well-being for all at all ages (WHO, 2017, NPHCDA,
2016). It has been observed that UNICEF-Assisted nutrition programme has had
positive effect on women’s nutritional status in Abia State (Udensi, 2014) but
the effect on children under-5years was not investigated. This informs the need
to investigate the effect of the programme on rural women and children
holistically since the programme is for mothers and children under-5 years in
rural communities in South-East Nigeria.
1.3 RESEARCH
QUESTIONS
The following research questions guided the study:
i.
What are the women participants’ perceptions of UNICEF-Assisted
nutrition programme activities?
ii.
What are the women participants’ perceptions of effect
of UNICEF-Assisted programme activities on health?
iii.
To what extent did the women participate in the
UNICEF-Assisted programme activities?
iv.
To what extent did the U5 children participate
in the UNICEF-Assisted programme activities?
v.
What is the nutritional status of the women participants?
vi.
What is the nutritional status of the U5
children participants?
vii.
Are there behavioural changes in the women
participants that resulted from their participation in UNICEF-Assisted programme
activities?
viii.
Are the UNICEF-Assisted programme activities
perceived effectivein the study area?; and
ix.
Are there constraints to effective participation
of the participants in the programme activities?
1.4 OBJECTIVES OF THE STUDY
The Broad objective of this study was to evaluate the effectiveness of
UNICEF-assisted nutrition and health programme on the rural women and children
U5 in South-East Nigeria. The specific objectives include:
i.
ascertain the women participants’ perceptions of
UNICEF-Assisted nutrition programme activities in the study area;
ii.
ascertain the women participants’ perceptions of
effect of UNICEF-Assisted programme activities on health;
iii.
determine the level of participation of the women
in the programme activities;
iv.
determine the level of participation of the U5
children in the programme activities;
v.
assess the nutritional status of the women
participants;
vi.
assess the nutritional status of the U5 children
participants;
vii.
ascertain the behavioural changes in the women
participants that resulted from their participation in UNICEF-Assistednutrition
and health programme activities;
viii.
ascertain the perceived effectiveness of
UNICEF-Assistednutrition and health programme activities; and to
ix.
analyse the constraints to effective participation
of women and children U5 in the UNICEF-Assisted Programme activities in the
study area.
1.5 HYPOTHESES
To realize the objectives of the study, the following hypotheses would be
tested,
Ho1 There is no
significant relationship between nutrition perceptions of women participants of
UNICEF-Assisted programme activities and their participation.
HO2 There is no
significant relationship between health perceptions of women participants of UNICEF-Assisted
programme activities and their participation.
HO3 Participation
of women in UNICEF-Assisted nutrition and health programme activities has no
significant effect on their nutritional status.
HO4 Participation
of U5 children in UNICEF-Assisted nutrition and health programme activities has
no significant effect on their nutritional status.
HO5 There is no significant
difference in the level of change in behaviour among the women participants of
UNICEF-Assisted nutrition and health programme in South-East (Abia, Ebonyi and
Enugu) States.
HO6 There is no
significant difference in the perceived effectiveness of UNICEF-Assisted nutrition
and health Programme activities across the South East (Abia, Ebonyi and Enugu)
States.
HO7 The constraints
to effective participation of women and children in the programme do not significantly
affect their participation.
1.6 SIGNIFICANCE
OF THE STUDY
Hunger and malnutrition occupy prominent position as factors that may
forestall the achievement of the Sustainable Development Goals (SDGs). The
study on evaluation of UNICEF-assisted nutrition and health programme for rural
women and children in South-East, Nigeria is important especially in this era
of global food crises and as a continuation from the point where the study on effect
of UNICEF-Assisted nutrition programme on women’s nutritional status in Abia
State stopped (Udensi, 2014), incorporating the U5 children and exposing their
status following their participation in the programme in the South-East region.
The women and children that participated in the programme will have ample
information on what good they have done to their health by participating in the
programme. This study contributed to the body of knowledge by providing
information on the current status of women and children in the south-eastern
Nigeria as well as factors impeding the success of UNICEF-Assisted nutrition and
health programme in the area. Furthermore, it will enable women to recognize
and appreciate how well the programme has helped them achieve their needs.
The findings of the study provide available materials for other
researchers interested in UNICEF nutrition and health programmes in the area.
It has provided various means of ameliorating malnutrition related problems.
The study has also provided information on thecurrent nutritional status of
women as an area of gap to be filled, aimed at enhancing their agricultural
productivity in the region. Husbands and other men concerned will come to know
the effect of their self-centred attitude on the nutritional well-being of
their spouses and children.
Community health workers and rural support group members who were
involved in the management of the health of rural women and their babies will
also benefit from the study. They will come to the realization of the effects
of their efforts in the fight against malnutrition and other nutrition-related
diseases that are associated with pregnant women, lactating mothers and their
babies in the region.
UNICEF and other NGOs that partner in the fight against maternal ill
health and infant mortality will also benefit from the study because the study
has unveiled the strengths and weaknesses of their programmes which should
enable them to reorganize their activities in order to be of more benefit to
the rural people. UNICEF’s substantial investment in nutrition and health
programmes needs extensive evaluation coverage in the study area. This study
has provided the needed coverage to support learning and performance
improvement in the study area. Furthermore, policy makers in health and women
development at the federal, state and local government areas will through the
study discover the need to live up to their responsibilities and for introduction
and sponsorship of viable programmes that will help reduce the numerous health
and social problems of rural women.
1.7 SCOPE OF THE STUDY
The study was carried out in South-East Nigeria. The population of the
study was made up of three states of Abia, Ebonyi and Enugu out of the five
states of the geo-political zone. The focus of the study was on rural women of
child bearing age (18-49) and children under five years of age, who
participated in the programme.
1.8 LIMITATIONS OF THE STUDY
Several challenges were encountered in the course of this research work.
Among such include the fact that many women participants were unwilling and
reluctant to respond to the questions raised in the questionnaire. This
however, necessitated the development of a strategy aimed at arousing and
sustaining the women’s interest to offer the needed assistance. The researcher
having noticed that a moi moi vendor that receives the highest patronage asked
her to serve all the women present, at another location egg was served all of
them present; at another location buns were given to them. It was only in one
of the locations that some five women ate jollof rice on the researcher.
Lack of time control was another problem encountered as most of the women
participants could not be reached individually in their homes; instead they
were met in groups especially on immunization days, and on maternal and
neo-born child health week (MNCHW) activitiesschedules which records high women
attendance. As immunization holds twice a month, the MNCHW programme is a
biannual health programme that offers the women access to healthcare free of
charge even deliveries made during this period are free. Most often the States’
primary healthcare development agency (SPHCDA)dates for these programmesclasheswith
others, thereby making it impossible for such ample opportunity to be utilized.
Finance was amajor challenge central to this study. Paucity of funds
reduced the paceat which this work was carried out. It also caused the researcher
trek some distances to reach these women in groups on their appointment days at
health centres, or otherwise would have to wait till there’s fund to embark on
the exercise.
1.9 DEFINITION OF TERMS
The following terms defined in this section were used by the researcher
in this study.
Stunting is a reduced growth
rate in human development. Stunting in this context means malnourishment.
U5 or Under-5 means under-five
children and would interchangeably be used in that regard to refer to children
less than five years of age in this study.
Nutritional status is the
condition of the body resulting from the nutrient content of the food we eat in
relation to our nutritional needs and from the ability of our bodies to digest,
absorb and use those nutrients. The BMI is the measurement of nutritional
status of the women in this study.
MUAC means the Mid Upper Arm
Circumference. It is the measurement of the nutritional status of the U5
Children in this study.
Health status refers to the
state of health of a person or a population accessed with reference to
impairments, morbidity, mortality and anthropological measurements and
indicators of functional status and quality of life (WHO, 2009).
Maternal mortality is the death of a
woman while pregnant or within 42 days of termination of pregnancy,
irrespective of the duration and site of the pregnancy, from any cause related
to or aggravated by the pregnancy or its management but not from accidental or
incidental causes.
Child mortality rate implies
the probability of a child dying between birth and exactly 5 years of age,
expressed per 1000 live births.
Infant mortality rate implies
the probability of a child dying between birth and exactly 1 year of age,
expressed per 1000 live births.
Neo-natal mortality rate
implies the rate of infant death during the first 28 days after live birth,
expressed per 1000 live births in a specific geographical area or institution
in a given time.
In this study, neo-natal mortality, infant mortality and Child mortality
was synonymously used as U5 children mortality rate.
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