Investigation Of Malnutrition In Pregnancy And Its Effect On Mother And Child, Using Mothers Attending Antenatal Clinic In Faith Mediplex Hospital, Benin City, Edo State

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Investigation Of Malnutrition In Pregnancy And Its Effect On Mother And Child, Using Mothers Attending Antenatal Clinic In Faith Mediplex Hospital, Benin City, Edo State (Danie)


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 an investigation of malnutrition in pregnancy and its effect on mother and child, using mothers attending antenatal clinic in faith mediplex hospital, Benin city, 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 mothers 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.


Table of Content


  • Title Page
  • Certification
  • Dedication
  • Acknowledgement
  • Table of Content
  • List of Tables
  • Abstract

Chapter One:

Introduction

  • 1.1 Background of the Study
  • 1.2 Statement of the Problem
  • 1.3 Objective of the Study
  • 1.4 Research Questions
  • 1.5 Research Hypothesis
  • 1.6 Significance of the Study
  • 1.7 Scope of the Study
  • 1.8 Limitation of the Study
  • 1.9 Definition of Terms
  • 1.10 Organisations of the Study

Chapter Two:

Review of Literature

  • 2.1 Conceptual Framework
  • 2.2 Theoretical Framework
  • 2.3 Empirical Review

Chapter Three:

Research Methodology

  • 3.1 Research Design
  • 3.2 Population of the Study
  • 3.3 Sample Size Determination
  • 3.4 Sample Size Selection Technique and Procedure
  • 3.5 Research Instrument and Administration
  • 3.6 Method of Data Collection
  • 3.7 Method of Data Analysis
  • 3.8 Validity of the Study
  • 3.9 Reliability of the Study
  • 3.10 Ethical Consideration

Chapter Four:

Data Presentation and Analysis

  • 4.1 Data Presentation
  • 4.2 Analysis of Data
  • 4.3 Answering Research Questions
  • 4.4 Test of Hypotheses

Chapter Five:

Summary, Conclusion and Recommendation

  • 5.1 Summary
  • 5.2 Conclusion
  • 5.3 Recommendation
  • References
  • APPENDIX
  • QUESTIONNAIRE

Chapter One


Introduction

1.1 Background to the Study

Malnutrition in pregnancy and 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 Objectives of the Study

The main objective of the study is an investigation of malnutrition in pregnancy and its effect on mother and child, using mothers attending antenatal clinic in faith Mediplex hospital, Benin city, Edo state. Specific Objectives;

  1. To determine the socio demographic factors of mothers associated with malnutrition in pregnancy
  2. To assess the relationship between children characteristics and malnutrition in pregnancy
  3. To determine the association between children caring practices and malnutrition in pregnancy
  4. To determine the association between environmental conditions and malnutrition in pregnancy

1.4 Research Questions

  1. What influence mother’s socio demographic and socio-economic factors have on malnutrition in pregnancy?
  2. What is the association between a child characteristic and malnutrition?
  3. Does a child care practice have an influence on malnutrition in pregnancy ?
  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 pregnancy malnutrition using mothers attending antenatal clinic in faith mediplex hospital, benin city, edo state. 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.


1.6 Scope of the Study

This study had some limitations, which include some of the following. The study will be a cross- sectional study so it was difficult to examine any potential temporal relationships or causal associations. In addition, hygiene practices were determined based on self-reported data from the caregivers, as well as other sanitation factors and socio-economic variables like level of income.

Most mothers did not carry along their record to health chart book, hence it was difficult confirming the immunization status of the child.


1.7 Limitation of the Study

The researcher encountered problems during the course of carrying out this research; such problems were as a result of selected respondents who refused to accept and participate and also encountered difficulty in acquiring relevant materials and items. The attitude of selected subjects to fill the questionnaire to time so as not to delay the result of the research also posed a problem. However, the researcher appealed to the participants through persuasive means.


1.9 Definition of Terms

It would be necessary at this point to make clear the meaning of some words used in this study.

Peculiar:

Strange, eccentric, belonging exclusively to one person or place or thing special.

Absorption:

Take in, combine into itself or oneself, combine into occupy the attention or interest.

Pathological:

Study of disease

Calorie:

Unit of heat, unit of the energy producing value of food

Typically:

Having the distinctive qualities of a particular type of person or thing

Extreme:

Very great or intense, at the end (s), outermost, going to great lengths in actions or views, extreme degree or act or condition.

Sufficient:

When something is enough

Term:

Fixed or limited period, period of weeks during which a law court holds sessions or school holds session.

Malnutrition:

Malnutrition, Malnourished, sick persons people suffering from deficiency.

Inadequate:

Not adequate, not sufficiently.


1.10 Organization of the Study

This research work is organized in five chapters, for easy understanding, as follows.

  • Chapter one is concern with the introduction, which consist of the (overview, of the study), historical background, statement of problem, objectives of the study, research hypotheses, significance of the study, scope and limitation of the study, definition of terms and historical background of the study.
  • Chapter two highlights the theoretical framework on which the study is based, thus the review of related literature.
  • Chapter three deals on the research design and methodology adopted in the study.
  • Chapter four concentrate on the data collection and analysis and presentation of finding.
  • Chapter five gives summary, conclusion, and recommendations made of the study.

Chapter Five


Summary, Conclusion and Recommendations

5.1 Summary of the Study

In this study, the indicators used in the assessment of malnutrition were height for age, weight for age and mid upper arm circumference measurement. A total of 328 children were assessed. The findings of the study showed that 78.05% were malnourished. About 3.66% had severe acute malnutrition and 15.85% had moderate acute malnutrition. Also 18.90% were severely underweight or wasted and 12.80 % were moderately underweight or moderately wasted. Again 39.08% were severely stunted and 16.62% were moderately stunted.

The United Nations Division for Sustainable Development (2007) and Macharia et al. (2005) describe stunting as the reflection of the cumulative effects of under-nutrition and infections. It serves as an indication of poor environmental conditions and long-term chronic restriction of a child’s growth potential. It was observed that the prevalence of stunting was lower in the first 6 months of life. The prevalence increased through 6-20 months and peaked (51.97%). This is in consonance with earlier work done by Badake et al. (2014) and Jayatissa et al. (2012). Badake et al, 2014 attributes this pattern to poor weaning and complementary feeding practices leading to inadequate protein and energy intake in the child. This can be caused by the caregiver’s lack of knowledge about proper infant and young feeding practices.

The prevalence of stunting was higher in males than females. This is a confirmation to the report of the GDHS 2008 that males are more likely to be stunted than females (GSS et al., 2009).

There was a significant association between stunting (height for age) in children and caregiver’s age. 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. Reports by Fall et al. (2015) in a similar study done in some selected low and middle-income countries revealed that the age of the mother was associated with stunting. Children with young mothers were more disadvantaged in childhood nutrition than those with older mother.
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. This is similar to an earlier finding by Jayatissa et al. (2012) in a similar study in Sri Lanka.

Children between the ages of 6-20 months had the highest prevalence (48.39%) of underweight. This could be because during this stage, exclusive breastfeeding has stopped and complementary foods introduced may be inadequate for the child or previous infection may have resulted in reduction in food intake of the child. This is likely the case since the median duration of exclusive breast feeding was 6months and also maternal antibodies clears after 6 months, hence the child would have been easily prone to infection during that time, Ajao et al. (2010) associates these reasons to households which might have food insecurity.

Similar to the findings of Akorede & Abiola, (2013), Asfaw et al. (2015) and Hailemariam, 2014) that some maternal, child and environmental factors were significantly associated with nutritional status, significant association was seen between some of these factors and nutritional status in the present study. Similarly, significant association were seen between child underweight or weight for age and some of the exposure variables, just as in Asfaw et al., (2015) and Mengistu et al. (2013) found them to be significantly associated.
Linking the results of the study to conceptual framework, some children and environmental factors were seen to be significantly associated to the child’s nutritional status as expected; and also, some maternal factors (caregiver age group) were seen to be associated with child nutritional status.

Knowledge on malnutrition, some good hygiene practices and available healthcare services in the community could have helped in improving the nutritional status of the children under- five.The study also showed quite significant number of the children had diarrhea (34.33%) and respiratory tract infection in their recent medical history (46.27%).Diarrhea is the leading cause of morbidity and mortality of children through dehydration and malnutrition. High magnitude of malnutrition observed among children who had diarrhea in the recent medical history. This is clear because there is a reciprocal relationship with diarrhea leading to malnutrition and malnutrition predispose to diarrhea (Bantamen et al 2014). The result of this study may suggest that children suffered from longer and repeated episodes of diarrhea, which determined their nutritional status. Diarrheal diseases in children under the age of five are an indicator of lack of basic sanitation.
A bivariate analysis between overall nutritional status and maternal educational and occupational showed that, there is no association between overall nutritional status and maternal educational level and occupation, contrary to a similar study done in Ethiopia using a case control approach, ( Bantamen et al 2014) which revealed that parental illiteracy was significantly associated with the risk to develop malnutrition in children under the age of five. Similar to this study, Nikoi (2011) found that in Ghana, parental education and occupation had no significant relationship with child nutritional status.

A bivariate analysis of source of drinking water showed a significant association with nutritional status that was similar to a study done in Ethiopia by (Bantamen et al 2014).

How hand is washed and use of toilet facility, which forms part of the mothers’ hygiene practices and sanitation factors respectively were significantly associated with nutritional status. These two factors synergistically contribute to diarrhoeal conditions in the child.
A very high percentage of the children had been fully immunized (96.34%) and 3.66% had been partially immunized. However, bivariate analysis with nutritional status showed no association.

More than half (54.44%) earned income <1000ghs and 45.56% earned income between 1000- 5000ghs. However, income was not significantly associated with nutritional status of the child.

The rate of malnutrition in under-fives in the community, were higher (76.05%) than expected and quite a significant number of mothers were teenagers (6.71%). This is an indication that to some extent, the community intervention must be put in place to reduce or end teenage pregnancy and improve sanitation factors and hygiene practices.


5.2 Conclusion

The following factors were associated with and contributed to the development of malnutrition among under five children in the study area. These factors are 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 higher proportion of malnourished children were in age group 6-20 months. Almost all the children had been fully immunized.


5.3 Recommendations

Malnutrition program should be strengthened and expanded by Ministry of Health. Mothers should be taught very nutritious meals to introduce as complementary meals when exclusive breast-feeding is stopped (after 6 months).

Measures should be put in place to reduce teenage pregnancy in the community by the Ministry of Gender, Women and Social Protection.
Good source of water by Nigeria Water Company should be made available to all homes.

Caregivers should be educated on the need to wash their hand with clean water and soap before preparing food, cleaning the child and after toilet Government should make it a policy for all homes to have good toilet facilities.


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