ABSTRACT
This study was carried out to assess the prevalence of severe acute undernutrition among school-age children between the age group of 6 – 12 years in Ujodo Development Centre, Enugu State. A total of 399 school children were selected using simple random sampling technique. Structured questionnaire was used to obtain information on socio-economic characteristics and dietary habit of the respondents. Anthropometric indices of the children was collected and grouped using WHO anthro plus. Data obtained were analyzed with SPSS version 20.0, using descriptive statistics such as frequencies and percentages and chi-square. The results showed that 22.1% of the children were eleven years. Most (60.9%) of the children lived with their parents, 20.3% of their parents earned N20,000 to N29,999 monthly. Some (35.6%) sourced their drinking water from stream and 34.8% boiled the water before drinking it. Also, 37.8% and 30.1% used uncovered latrine and pit toilets. Meal skipping was among 49.6% of the children with 41.1% skipping breakfast. All the children consumed snacks such as biscuit, buns, egg roll, cheese ball, twice a week (52.6%). Similarly. Fruits and vegetable were consumed by 54.1% of the children two times a week. Their 24-hour dietary recall indicated that carbohydrate rich foods such as garri and soup, rice and yam which was complemented with beans and fiofio and oil was mostly consumed by the children. Prevalence of stunting and wasting was among 7.8% and 30.8% of the children. It was also observed that family size significantly (p<0.05) affect the height-for-age of the children. Also, educational levels of their mothers significantly (p<0.05) affect their BMI-for-age. Level of wasting among these children shows the need for the parents of these children to diversify the foods given to them by including meat, fish and dairy products in their diets.
TABLE
OF CONTENTS
Title Page i
Certification ii
Dedication iii
Acknowledgements iv
Table of Contents v
List of tables viii
Abstract ix
CHAPTER
1
INTRODUCTION
1.1 Statement of the Problem 2
1.2 Objective of the Study 4
1.3 Significance of the Study 5
CHAPTER
2
LITERATURE
REVIEW
2.1 Global Occurrence of
Malnutrition 11
2.1.1 Occurrence of Malnutrition in
Nigeria 15
2.1.2 Occurrence of Malnutrition in
Peru 16
2.1.3 Occurrence of Malnutrition in
Uganda 17
2.1.4 Occurrence of Malnutrition in
Ghana 17
2.1.5 Occurrence of Malnutrition in
Kenya 18
2.1.6 Occurrence of Malnutrition in
Somalia 18
2.1.7 Occurrence of Malnutrition in
Yemen 19
2.2 Forms of Malnutrition 19
2.3 Types of Malnutrition 20
2.4 Indicators of Malnutrition 21
2.4.1 Stunting as an indicator of
malnutrition 21
2.4.2 Wasting as an indicator of
malnutrition 22
2.4.3 Underweight as an indicator of
malnutrition 22
2.5 Signs of Severe Acute
Malnutrition 24
2.6 Causes of Severe Acute
Malnutrition 25
2.7 Health Effect of Severe Acute
Undernutrition 27
2.8 Economic Consequences of
Malnutrition 29
2.9 Assessment of Malnutrition 30
2.10 Management of Severe Acute
Malnutrition 31
2.11 Prevention and Treatment of
Malnutrition 32
CHAPTER
3
MATERIALS
AND METHOD
3.1 Study Design
3.2 Area of Study 34
3.3 Population of Study 34
3.4 Sampling and Sampling Technique 35
3.4.2 Sampling procedures 36
3.5. Preliminary Activities 37
3.6 Data Collection 38
3.7 Data Analysis 40
3.8 Statistical Analysis 41
CHAPTER
4
RESULT
AND DISCUSSION
4.1 Socioeconomic Factors that are
Affecting the Nutritional Status of the Children 42
4.2 Dietary Intake Pattern of the
Children 52
4.3 24-Hour Dietary Recall of the
Children 57
4.4 Anthropometric Status of the
Children 61
4.5 Relationship Between
Anthropometric Status of the Children and
Socioeconomic Characteristics of their Parents 64
CHAPTER
5
CONCLUSION
AND RECOMMENDATIOS
5.1 Conclusion 68
5.2 Recommandations 68
References 70
Appendix 85
LIST
OF TABLES
Table 4.1: Personal information of the children 43
Table 4.1b: Socioeconomic Characteristics of the Children’s Parents 46
Table 4.1c: Toilet facilities and source of water of respondents 49
Table 4.1d: Hygiene and healthcare practices of caregivers 51
Table 4.2a: Food Intake Pattern of the Children 54
Table 4.2b: Fruits and vegetable consumption pattern 56
Table 4.3a: 24-Hour Dietary Recall of the Children 58
Table 4.3b: 24-Hour Dietary Recall of the Children 60
Table 4.4: Anthropometric Status of the Children 63
Table 4.5a: Relationship Between height-for-age of the children and
Socioeconomic
Characteristics of their Parents 65
Table 4.5b: Relationship Between BMI-for-age of the children and
Socioeconomic
Characteristics of their Parents 67
CHAPTER 1
INTRODUCTION
The
success of child survival programmes and the expansion of basic education
coverage have resulted in a greater number of children reaching school-age with
a higher proportion actually attending primary school (World Bank, 2000).
However, there is increasing evidence, with resulting international concern,
that the high level of nutritional deprivation combined with the heavy burden
of disease in this age group has negative consequences for a child's long term
overall development. This has prompted an increased focus on the diverse needs
of the school-age child. An understanding and awareness of the heavy burden of
severe acute undernutrition among school-age children is growing although until
recently there have been relatively few large scale surveys that document
levels of morbidity in any detail (ACC/SCN, 2000).
While a better picture of the health and nutrition status of this age group is
being built, the true extent of the burden of ill-health and acute
undernutrition is still not fully known (Partnership
for Child Development, 1998).
The
common term malnutrition can refer to either overnutrition or undernutrition,
neither of which is conducive to good health (Byrd-Bredbenner et al., 2014). Malnutrition refers to
disorders resulting from an inadequate diet or from failure to absorb or
assimilate dietary elements. Some definitions focus on lack of nutrient intake,
for example, ‘Malnutrition is the cellular imbalance between the supply of
nutrient energy and the body’s demand to ensure growth maintenance and specific
functions’ (Olwedo and Mworozi, 2008). Byrd-Bredbenner et al. (2014) stated that undernutrition occurs when nutrient
intake does not meet nutrient needs, causing surplus store to be used. Once
nutrient stores are depleted and tissue concentrations of an essential nutrient
fall sufficiently low, the body’s metabolic processes eventually slow down or
even stop. Malnutrition according to Kings and Burgues (1992), is also seen as
a nutritional disorder caused by eating too little or too much of one or more
different nutrients that affects the body adversely. The effect is often
worsened by infection. It can also be seen as a condition when there is a
reduction or excess in both quantity and quality of certain food nutrients in
the body. It is a situation where the body does not have enough nor has excess
nutrients to perform daily activities and child manifest signs and symptoms
(Okoli, 2009). Malnutrition is common among children in developing countries.
Children in such countries have low food intakes deficient in both energy and
protein (and other essential nutrients).
1.1 STATEMENT
OF THE PROBLEM
Primary
school-age is a dynamic period of physical growth and mental development of the
child. The nutritional problem has a wide spectrum, on one end it is
represented by severe acute malnutrition (marasmus and kwashiorkor), while the
other end is represented by obese children. In addition, among this age group,
the most significant micronutrient deficiencies include vitamin A and iron
deficiencies (SCN, 2002).
The
prevalence of severe acute malnutrition is severe and can have affects well
into adulthood. A child suffering from severe acute malnutrition will undergo
more frequent, long lasting, and severe illness than a child receiving proper
nutrition (Barrientos, 2011). In addition, researchers attribute higher
mortality and an increased prevalence of stunting and wasting to the existence
of malnutrition during childhood (Alderman, 2007; Saloojee et al., 2007). Without proper nutrition during a child’s development,
he or she can experience delayed motor skills (Action Against Hunger, 2006),
lower cognition and school performance and detrimental effects on intelligence
(Setboonsamg, 2002). An adult, who suffered from severe acute malnutrition as a
child, will have reproductive difficulties, diminished work performance and
potentially unhealthy offspring. Also, being deficient in specific
micronutrients or proteins can result in serious illness and disability, for
example Kwashiorkor and Marasmus both protein deficiency diseases can result in
oedema, decreased muscle mass, changes in skin colour, and severe wasting of
both muscle and tissue (Barrientos, 2011). The management of severe acute
undernutrition is critical for child survival. Governments face great
challenges in building capacity and providing sufficient resources to prevent
and treat severe acute malnutrition, while a significant number of acutely
malnourished child live in countries where cyclical food insecurity and
protracted crises further exacerbate their vulnerability, many more are in
developing countries not affected by emergencies. The result is significant
barriers to sustainable development in these nations. In 2013, an estimated 2.9
million children were admitted globally for treatment of severe acute
malnutrition. This figures represent significant progress when compared with
just over one million report during 2009 (Ubesie and Ibeziakor, 2012), yet is
clearly insufficient when compared to the global burden of 17 million children
affected by severe acute malnutrition (UNICEF, WHO, World Bank, 2014). In light
of the growing understanding of the links between episodes of severe acute
malnutrition and stunting, it is clear that prevention and treatment of severe
acute malnutrition is critical to child survival and development (UNICEF,
2015). In addition to the physical and cognitive consequences, severe acute
malnutrition can have devastating effects on the economy. According to the
World Bank, malnutrition affects the economy of a country in three ways:
directly through a loss of productivity, indirectly through a loss of cognitive
function, and losses caused by accrued healthcare costs. The loss of
productivity can cost an individual suffering from malnutrition 10% of his or
her lifetime earnings, which can translate into a 2-3% loss in gross domestic
product.
1.2 OBJECTIVE
OF THE STUDY
1.2.1 General Objective of the Study: The general objective of the study
was to assess the prevalence of severe acute undernutrition among school-age
children between the age group of 6-12 years in Ujodo Development Centre, and
will provide a baseline data for future research.
1.2.2
Specific Objectives of
the Study: The specific objectives of the study are to:
- assess the socioeconomic
factors that are affecting the nutritional status of the children.
- assess the food of the children
using the 24-hour dietary recall and food frequency.
- assess the nutritional status
of the children using anthropometry.
- determine the relationship
between the anthropometric status of the children and the socioeconomic
characteristics of their parents.
1.3
SIGNIFICANCE OF THE
STUDY
It
has been noted that man is what he eats, and a healthy nation is a wealthy
nation therefore, this study will be a succor to the government of our country
Nigeria on the need to implement a comprehensive school health programme and
nutritional programme which has to be implemented uniformly based also on extra
needs of micronutrient needs in certain geographical regions of the country,
where severe acute undernutrition is common. So that in the future to come, we
will produce a better, healthy and wealthy nation. It will help to adopt a more
intensive approach to address the health and nutrition issues of this age group
(Grodner et al., 2004).
Malnutrition
is associated with concurrent risk of health and development of school age
children which results in adult shorter height which decreases work capacity
and increases reproductive risk for women. This research will be of importance
to future and expectant mothers, because good nutrition protects mothers from
giving stillbirth, low birth weight babies as well as post-partum haemorrhage
(Nwagha et al., 2008; Ogbodo et al., 2009). This is why it is affirmed
for a woman to be pregnant and have normal delivery, she must have well
developed pelvis which is the function of adequate nutrition (Sharma et al., 1999).
The
study will also help in educating the parents and community about the local
available energy dense food which is readily, cheaply and easily available. It
will stimulate further researcher in the subject which might lead to more
sensitization on the need for effective method of prevention of the condition,
and this will add to the growth and development of nutrition and other health
related profession.
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