ABSTRACT
This study assessed malnutrition among children 2-5 years in Umuafai, Umuezeala and Umuanna communities in Umuahia North Local Government Area (LGA) Abia State. The study employed a cross sectional survey study design. The sample size of this study comprised of three hundred and eighty two (382) children aged 2-5 years, randomly selected in the study area. A structured, easy-to- comprehend questionnaire was used to collect data for the study. The questionnaire was validated by lecturers in the Department of Human Nutrition and Dietetics, Michael Okpara University of Agriculture, Umudike, Abia State. Data collected was analyzed using descriptive statistics of frequency, percentage as well as presentation of results on tables. The study found that; majority of the children (51.6%) were within the age range of 4 to 5 years. Majority (56.3%) were males. The result also showed that majority had fairly good feeding habit with snacking as the major unhealthy dietary habit. Anthropometric result from the weight-for-height z-score, height-for-age z-score, weight-for-age z-score and body mass index for age z-score showed that there was no significant difference in the anthropometric characteristics of boys and girls (p= >0.05). There was a significant difference in the height-for-age z-score, weight-for-age z-score and body mass index for age z-score of children aged 2-3 years and 4-5 years (p= <0.05). Mid-upper arm circumference was seen to be normal for both genders and age groups. The prevalence of wasting, stunting, underweight and overweight were found to be 16.2, 9.7%, 10.2% and 6.0% respectively. The prevalence of wasting and overweight among the children was seen to be of concern in comparison to the WHO classification for public health significance. Also the study found that there is a positive relationship (p= <0.05) between malnutrition and maternal education, household income, birth weight and mother’s age. Considering the findings and conclusion of this study, it was recommended that Nutrition education programmes should be developed and implemented for parents in these communities and regular anthropometric checkups should be carried out in these communities to encourage child growth monitoring.
TABLE OF CONTENTS
Title page i
Certification ii
Dedication iii
Acknowledgement iv
Tables of Contents v
List of Tables viii
Abstract ix
CHAPTER 1
INTRODUCTION
1.1 Background of the Study 1
1.2
Statement of the Problem 3
1.3
Objective
of the Study 4
1.3.1 General objective of the
Study 4
1.3.2 Specific objectives of the
Study 5
1.4
Significance of the Study 5
CHAPTER 2
LITERATURE REVIEW
2.1 Concept of Malnutrition 6
2.1.1 What is Malnutrition 7
2.2
Forms of Malnutrition 8
2.2.1
Over nutrition 8
2.2.2
Under nutrition 9 2.3 Scope of the problem
(Malnutrition) 12
2.4 Epidemiology
of Malnutrition in Nigeria 13
2.5
Etiological factors of Malnutrition 14 2.6 Determinants of Malnutrition 16
2.7
Childhood Malnutrition 18
2.7.1
Global Trends in Malnutrition 20
2.7.2
Childhood Malnutrition in Nigeria 22
2.8
Malnutrition Management 25
2.8.1
Pathophysiology of Malnutrition 25
2.8.2
Diagnosis and measurement of Malnutrition 26
2.8.3
Prevention of Malnutrition 27
2.8.4
Treatment of Malnutrition 29
CHAPTER 3
MATERIALS AND METHODS
3.1
Study Design 31
3.2
Area of Study 31
3.3
Population of the Study 32
3.4
Sampling and Sampling Techniques 32
3.4.1
Sample size 32
3.4.2
Sampling procedure 33
3.5
Preliminary Activities 34
3.5.1
Preliminary visits 34
3.5.2
Informed consent 34
3.5.3
Training of research assistants 34
3.5.4 Validation and pretesting of
questionnaires 34
3.5.5 Ethical approval 34
3.6
Data Collection 35
3.6.1
Questionnaire administration 35
3.6.2
Interview 35
3.6.3 Anthropometric Measurements 35
3.7 Data Analysis 36
3.8
Statistical Analysis 37
CHAPTER 4
RESULTS AND DISCUSSION
4.1 Basic characteristics of the children aged 2-5 years 38
4.2 Socio-demographic
characteristics of the Parents 41
4.3 Feeding habits of the children aged 2-5 years 45
4.4 Anthropometric characteristics of children 2-5 years according to sex 47
4.5 Anthropometric characteristics of children 2-5 years according to age 50
4.6 Socio-demographic and other factors
associated with malnutrition 52
CHAPTER 5
CONCLUSION
5.1
Conclusion 55
5.2 Recommendation 56
REFERENCES 58-68
APPENDIX I
APPENDIX II
APPENDIX III
APPENDIX IV
LIST OF TABLES
Table
4.1: Basic characteristics of the children aged 2-5 years 39
Table
4.2a: Socio-economic
and demographic characteristics of the parents
42
Table
4.2b: Socio-economic
and demographic characteristics of the parents
43
Table
4.2c: Ownership of household facilities 44
Table 4.3: Feeding
habits of the children 46
Table 4.4: Anthropometric characteristics of the children according to sex 48
Table 4.5: Anthropometric characteristics of the children according to age 51
Table 4.6:
Socio-demographic and other factors associated with malnutrition53
CHAPTER 1
INTRODUCTION
1.1 BACKGROUND OF THE STUDY
Malnutrition is known to be a major concern for the health systems
and entire society (Alemu et al.,
2014). It is said to occur when a person’s weight for age, height for age and
weight for height indices are below the standard (Z-score) used in classifying
malnutrition (World Health Organization, WHO, 2018). In addition to being a
major public health problem, malnutrition remains the major risk factor for
diseases commonly seen in children less than five years. Although the United
Nations has adopted the Millennium Development goals aimed at reducing childhood
malnutrition by half, malnutrition still remains the major cause of death among
under five children (Sarraf et al.,
2005).
Malnutrition
is caused by reduced intake of food/nutrients, excessive consumption and
imbalances in food and nutrient consumption. It can be under nutrition or over
nutrition (WHO, 2018). Under nutrition is a major health problem that is commonly
associated with children in developing countries (Goon et al., 2011). It causes
an increase in disease and death rate in children, especially those in low and
middle income countries (WHO, 2018). According to World Bank (2014), billions
are lost in revenue due to reduced economic productivity, days away from work
due to illness and money spent on treating ailments as a result of
malnutrition. Malnutrition also causes about 300,000 deaths every year
resulting to more than half deaths in child mortality (Alemu et al., 2009).
Currently,
about 60 million children in the world are affected with moderate acute
malnutrition while 13 million are affected with severe acute malnutrition
(Islam et al., 2017). Reports by De
Onis et al. (2018) and WHO (2019)
have shown that about 21.9% and 13.4% of children under-five years of age are
stunted and underweight respectively while 7.3% and 5.9% are wasted and obese
respectively. It has been reported that about
2.7 million deaths in 5.4 million under-five deaths occur in African countries
including Nigeria each year (Hug et al.,
2017).
Some
studies carried out in south eastern Nigeria have also shown the prevalence of
under five stunting. In a small population of 66 under 5 children, about 2.4%
and 3.5% were wasted and stunted respectively while 3% were obese (Jude et al., 2019). Ayogu et al. (2018) reported that in a rural
community in Enugu state, south eastern Nigeria, about 41.6% 0f children were
stunted while 18.2% were underweight. Another study in Abakiliki, Ebonyi state
has shown that about 37.3% of the study population were underweight while 19.3%
were stunted (Onyeire et al., 2015).
The use of Malnutrition
Screening Tools (MST) for early detection of patients who are not at risk and
those who are malnourished is necessary to improve the health outcomes of
children (Briend et al., 2012). In
Sub- Saharan Africa, MST commonly used to classify indicators (stunting,
wasting, underweight and obesity) in children under 5 years include the use of
anthropometric measurements such as height for age, weight for height, weight
for age and mid-upper arm circumference (Feixeira and Viana, 2016). It is
important that MST follow effective processes as the correct interpretation of
these tools are crucial for improving early detection and care linkage in
malnourished children (Fox et al., 2012).
According
to Deepti et al. (2020), it is seen
that a high risk of malnutrition in children under 5 is associated with
Parent’s education, family income, breastfeeding and young child feeding
practices. Also, diarrhea, low birth weight (<2.5kg), unsafe drinking water
and unhygienic environment are associated with malnutrition in children less
than five years (Berhanne and Tigist, 2019). Other factors such as gender,
religion and ethnicity are not usually found to be associated with malnutrition
(Deepti et al., 2020).
It is important to tackle the issue of
childhood malnutrition for healthy growth and development. Adequate nutrition
is therefore essential for healthy growth and development during childhood
(Black et al., 2008).
1.2 STATEMENT OF THE PROBLEM
Malnutrition is a major contributor to childhood morbidity and
mortality. In 2012, malnutrition was seen to be the cause of 6.6 million
under-five death in the world (WHO and United Nations Children’s Fund, 2012;
UNICEF, 2013). As at 2011, the prevalence of stunting, underweight and wasting
among under-fives in Nigeria was 35.8%, 24.2% and 10.2% respectively (National
Bureau of Statistics, NBS, 2011). There has been no significant reduction of
these figures even up till the year 2018.
Under nutrition is most likely prevalent in low and middle income
countries (WHO and UNICEF, 2012). This leads to diseases and death, revenue
loss, reduced economic productivity and low development rate (UNICEF, 2013). Malnutrition
has negative impacts on families, communities and the society at large. They
could be in various aspects such as economically, socially and medically.
This nutrition situation is characterized by a double burden of
malnutrition with about one third of children under-five years stunted (more
than half in the northwest). Each year about 11 million Nigerian children die
before their fifth birthday. Malnutrition contributes to nearly half of these
deaths. It is against this background that this study was designed.
1.3 OBJECTIVES OF THE STUDY
1.3.1 General objective of
the Study
The general objective of this study is to determine the prevalence
of malnutrition among children 2-5 years in urban communities (Umuafai,
Umuezeala and Umuanna) in Umuahia North Local Government Area (LGA), Abia
State.
1.3.2 Specific objectives of
the Study
The specific objectives are to;
1. determine
the socio-economic status of the children’s parents.
2. evaluate
the feeding habits of the children.
3. assess
the prevalence of wasting, stunting, underweight and obesity among children 2
to 5 years of age.
4. examine
the socio-demographic and other factors associated with malnutrition among
children 2 to 5 years of age.
1.4 SIGNIFICANCE OF THE STUDY
Evaluation of prevalence of malnutrition among children of 2 to 5 years using z-score is a
very vital issue often under reported in pediatrics practice and in this part
of the world. Its importance therefore cannot be overlooked especially its impact
on health which had been mentioned above.
The findings will help to
know the burden of malnutrition and establish baseline data where other related
issues will hinge on. It is hoped that
this will add to the body of knowledge available on malnutrition and the
findings of this study could form the template for intervention strategies in
helping to reduce the prevalence and managing such cases. Fellow researchers
reviewing literature and who wish to learn from the experience of previous researchers on a similar subject
will also find the work useful.
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