ABSTRACT

Malnutrition continues to be a significant public health and development concern globally. It is a serious problem because it is causing the deaths of 3.5 million children under 5 years old per- year. Its magnitude is still high in sub Saharan countries including Nigeria. The main objective of this study therefore, was to assess associated factors of malnutrition in under five years children in Ewoyi community in Esan North east Uromi Edo state. A hospital based cross-sectional study was conducted in July 2018 to assess the nutritional status of children aged zero to fifty-nine (0-59) months in the facility to identify factors leading to malnutrition in the community. A total of three hundred and twenty-eight (328) children and their caregivers participated. A pre-tested, structured, interviewer administered questionnaire consisting of mothers’ childcare practices, mother and child socio-demographic factors and anthropometric measurement was used to gather data. A systematic sampling method was used in sampling the caregivers over a three-week period. Nutritional indices measured were height, weight and mid upper arm circumference. Data was entered into Microsoft Excel 2013. WHO Anthro Plus software version 3.2.2 was used in determining the z-scores and STATA 15 was used to perform univariate and multiple logistic regression analysis. The prevalence of malnutrition was 78.05%. The prevalence of stunting and underweight were 55.7% and 31.7% respectively. Also, 3.85% had severe acute malnutrition and 15.85% had moderate acute malnutrition. 6.71% of mothers were less than 20 years (teenagers), which was quite significant percentage of teenage mothers and 93.29% were adult mothers. The following factors were found to be associated and contributed to the development of malnutrition among under five in the study area. These factors were: maternal age, hygiene practice of the mother, sanitation factors, source of drinking water, recent medical history of diarrhea or respiratory tract infection. It was also noticed that the highest proportion of malnourished children were in age group 6-20 months.

From the multivariate analysis, older mothers were less likely to have a stunted child than a young mother for all various age groups in reference to age less than 20 years. Though the lowest prevalence of underweight was seen in those who were 0-6 months (6.45%), there was no pattern in the prevalence of underweight with increasing age

These findings suggest that education on infant and young child care and feeding practices need to be re-structured to suit the population. In addition, more efforts such as periodic assessments need to be put into existing interventions to help reduce the prevalence of malnutrition.

CHAPTER ONE

INTRODUCTION

1.1 Background to the study

Malnutrition in children is a major public health problem, especially in many low-income and middle- income countries. It adversely affects the productivity of nations as well as creating economic and social challenges among vulnerable groups. Poor nutrition is associated with suboptimal brain development, which negatively affects cognitive development, educational performance and economic productivity in adulthood. (Coulter,2014).

Malnutrition is a broad term and it is usually referred to as undernutrition and it encompasses all forms of nutritional disorders and includes both overnutrition and undernutrition (WHO Nutrition 2016)

WHO defines malnutrition as; the cellular imbalance between the supply of nutrients and energy the body demands to ensure growth maintenance and specific functions. Malnutrition can be termed as chronic malnutrition (stunting) and acute malnutrition (underweight and wasting). It can be termed as macronutrient deficiency malnutrition (Protein-Energy Malnutrition) or micronutrient deficiency malnutrition e.g, iron etc. There are two main forms of acute malnutrition, which are marasmus and kwashiorkor(WHO Nutrition, 2016).

Child growth is the most widely used measure of children’s nutritional status. The first 1000 days of life, (0-23months) is a very critical phase in a child's life during which rapid physical and mental development occurs (Walker et al. (2007)

The new SDGs state that eradication of extreme poverty and hunger by halving the number of people living on less than $1.25 a day and the number of people suffering from hunger.

Of even more significance are the uneven rates of achievement in different parts of the globe. For instance, the largest decline in the prevalence of malnutrition has been in East Asia, especially in China, while substantial improvements have been made in Latin America and the Caribbean. However, less progress was seen in South Asia, where the prevalence of underweight remains very high, while sub-Saharan Africa saw little or no change over the period 1990-2011.

Undernutrition during this critical phase can have irreversible consequences on the child's growth leading to an increased risk of morbidity and mortality in children (Murray-Kolb., et al 2013). Undernutrition is commonly assessed through the measurement of a child's anthropometry (height, weight), as well as through screening for biochemical and clinical markers. Wasting, stunting and underweight are expressions of undernutrition and the anthropometric indicators for the assessment (Duggan et al., 1999).

1.2 Statement of Problem

In 2015, globally about 7.7% of children were wasted, 24.5% were stunted and 15% were underweight. In that same year, malnutrition contributed to about 45% of deaths in children below five years. The African region and South-East Asia have reported the highest prevalence of undernutrition, with the former accounting for about 39.4% of the stunted, 24.9% of the underweight and 10.3% of the wasted children under-5 years of age. (Sulaiman et al., 2018).

According to the 2015 Millennium development goal (MDG) report, sub-Saharan Africa (SSA) accounts for one third of all undernourished children globally, with West Africa and East Africa having the highest prevalence, highlighting that malnutrition still remains a major health concern for children under 5 years in the sub-region, thus buttressing the need for urgent intervention (Luchuo et al. 2013).

Over nutrition on the other hand is not really a problem of Africa. However, it is increasing gradually in southern part of Ghana. A study conducted in 2015 by UNICEF in Ghana indicated that 23% are stunted (7% severely); and 6% are wasted (1% severely), 13% of children under five are underweight (3% severely). These figures show that malnutrition is still high in the country or the Sub-Saharan region (UNICEF 2015).

Despite interventions like school feeding program, improved primary health care and many more, malnutrition is still high. Malnutrition has been directly linked to low socio-economic status studies done in Ethiopia (Bantamen et al. 2014) Malnourished children usually share common factors. They are typically from low socio- economic communities in resource poor countries (Bantamen et al. 2014).

This study seeks to assess factors associated with malnourished children and the extent to which they contribute to the condition or its complications.

1.3 Objectivesof the study

The main objective of the study is to assess the various factors contributing to malnutrition in children between the age 0-5years in Ewoyi Community.

Specific Objectives;

1. To determine the socio demographic factors of mothers associated with under five malnutrition

2. To assess the relationship between children characteristics and under five malnutrition

3. To determine the association between children caring practices and under-five malnutrition

4. To determine the association between environmental conditions and under five malnutrition

1.4 Research Questions

1. What influence mother’s socio demographic and socio-economic factors have on under five child malnutrition?

2. What is the association between a child characteristic and under five-year malnutrition?

3. Does a child care practice have an influence on under five-year malnutrition?

4. What is the relationship between environmental conditions of a child and under five malnutrition?

1.5 Significance of the study

It was important to undertake this study because of the numerous benefits to has offered for improving good nutrition among children. The study provides information on prevalence and associated risk factors of child malnutrition in Ewoyi community . It has helped in identifying factors that are barriers to good nutrition practice, and translate each guideline into specific recommendations that health care providers, mothers, non-governmental organizations (NGOs) and  agencies such as Ministry of Health (MoH) and Nigeria Health Service (NHS) needs to develop the right measures of improving and eradicating malnutrition among children. The information provided in this study would also be used in planning interventions concerning malnutrition, particularly child malnutrition.