Malnutrition In Rural Communities And The Factors Affecting Food Choice

Project and Seminar Material for Public Health

Malnutrition In Rural Communities And The Factors Affecting Food Choice

Abstract

This study was carried out on malnutrition in rural communities and the factors affecting food choice using Okat community in Onna local government of Akwa Ibom State as a case study. The study is was specifically set to ascertain whether rural dwellers have adequate knowledge of the proper nutritional intake, determine the extent of prevalence of malnutrition in rural communities, determine whether the food choices of rural dwellers contributes to the height of malnutrition in the communities, examine the factors affecting the food choices in rural communities. The survey design was adopted and the simple random sampling techniques were employed in this study. The population size comprised residents in Okat community in Onna local government of Akwa Ibom State. In determining the sample size, the researcher conveniently selected 147 respondents and 141 were validated. Self-constructed and validated questionnaire was used for data collection. The collected and validated questionnaires were analyzed using frequency tables, and mean scores. The hypotheses was tested using Chi-square Statistical tool. The result of the findings reveals that rural dwellers does not have adequate knowledge of the proper nutritional intake. The study also revealed that the factors affecting the food choices in rural communities includes: poor income status, family background, lack of proper nutritional knowledge, cultural beliefs, inadequate food security. Therefore, it is recommended that to reduce the present high rate of malnutrition in the rural areas, the study suggests the targeting of women with education programmes and provision of clean water, including the enforcement of healthy environment in the rural areas. To mention but a few.

Table of Content

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 Organization 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 of the Study

Malnutrition according to world health organization (2016), Malnutrition is a condition that results from deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients. The term malnutrition covers two broad groups of conditions. One is ‘under nutrition’—which includes stunting (low height for age), wasting (low weight for height), underweight (low weight for age) and micronutrient deficiencies or insufficiencies (a lack of important vitamins and minerals). The other is overweight, obesity and diet-related no communicable diseases (such as heart disease, stroke, diabetes and cancer)

However according to Anderson AS, Anil Ray (2012), William Blake (2004), Hossain M, Massan MQ, Rahman MH, Kabir AR, (2009), Malnutrition can also occur when an individual’s diet does not provide him/her with adequate calories and proteins needed for maintenance and growth or they cannot fully utilize the food they eat due to illness (under nutrition), while those who suffer from over nutrition consumes too much calories. Malnutrition is not exclusively a problem of extreme poverty, nor only of the young, but affects all communities around the world and people of all ages including pregnant women.

Globally, Malnutrition is regarded as the most important risk factor for illness and death and it is associated with 52.5 % of all deaths in young children (Müller O, Krawinkel M, 2005). According to UNICEF, WHO and the World Bank, out of the 161 million under-fives estimated to be stunted globally in 2013, over a third resided in Africa. It is considered is a major cause of child morbidity and mortality globally. There are several interventions to prevent the condition, but it is unclear how well they are taken up by both malnourished and well-nourished children and their mothers and the extent to which this is influenced by socio-economic factors (Tette, E. M., Sifah, E. K., & Nartey, E. T, 2015).

Despite impressive progress in reducing hunger and poverty, about 800 million people worldwide continue to suffer from undernourishment. Food insecurity and malnutrition are problems affecting rural areas, as part of a pattern of deep-rooted spatial inequalities. Conventional sectoral agriculture and food policies often overlook such territorial disparities and, consequently, are unlikely to suffice to meet the sustainable development goal of ending hunger and achieving food security for all by 2030 (Cistulli, V., M. Heikkilä and R. Vos, 2016).

Improving the educational status of parents, especially of mothers, on nutrition, sanitation and common disease prevention strategies should logically reduce the malnutrition related mortality and morbidity. It is said that the way to the child’s stomach is through the mind of the mother. Quality of food taken, choices and quantity are all at the discretion of the mother or care giver. This problem is very crucial in Sub Saharan Africa, where access to formal education for the girl child in certain communities is still a major burning challenge. The burden of malnutrition has been directly linked to poverty, quality of food intake, excessive disease and poor health status (World Bank. 2006).

Economic growth and human development require well nourished populations who can learn new skills, think critically and contribute to their communities. Economic development is normally accompanied by improvements in a country’s food supply and the gradual elimination of dietary deficiencies, thus improving the overall nutritional status of the country’s population. However this Food and Agriculture Organisation (FAO) report points out that increasing urbanization in poor countries has consequences which are not always positive. In countries with widespread deprivations, when food supply becomes more abundant, there occur changes in diets, patterns of work and leisure —often referred to as “nutrition transition”. The diet shifts towards a higher energy density with a larger role of fat and sugars in foods. The greater saturated fat intake, reduced fruit and vegetable intake and reduced intake of complex carbohydrates and dietary fiber may have negative consequences. These dietary changes along with reduced physical activity result in obesity and an epidemic of non-communicable diseases in developing countries (World Bank. 2006).

1.2 Statement of the Problem

Malnutrition continues to be a major public health problem in developing countries. It is the most important risk factor for the burden of disease causing about 300, 000 deaths per year directly and indirectly responsible for more than half of all deaths in children. (Müller O, Krawinkel M, 2005). In Nigeria, it is one of the main cause of morbidity and mortality in rural areas among other diseases (Demissie S, Worku A, 2013).

In Nigeria, Malnutrition, especially among rural dwellers, is not mirroring improvements in food security because of high rates of disease, lack of safe water and lack of access to basic health care. Diarrhoea and other illnesses prevent children in these areas from absorbing nutrients, so even where there is improved access to food, children can still be dangerously malnourished. Those in conflict-affected areas, especially the 1.4 million people who are internally displaced – more than half of whom are children – are the most at risk (UNICEF, 2014).

Lack of mother’s education and knowledge about Malnutrition in children under five years of age could be the contributing factors of malnutrition among children in Nigerian rural areas. Evidence shows that it is important for mothers to know about nutrition for the well being and healthy development of young children. This study intends to examine malnutrition in rural communities and the factors affecting food choice.

1.3 Objectives of the Study

The major purpose of the study was to examine malnutrition in rural communities and the factors affecting food choice. Specifically, the study sought to:

  1. Ascertain whether rural dwellers have adequate knowledge of the proper nutritional intake.
  2. Determine the extent of prevalence of malnutrition in rural communities.
  3. Determine whether the food choices of rural dwellers contributes to the height of malnutrition in the communities.
  4. Examine the factors affecting the food choices in rural communities.
    1. Poor income status
    2. Family background
    3. Lack of proper nutritional knowledge
    4. Cultural beliefs
    5. Inadequate food security

1.4 Research Questions

These research questions will be answered in this study:

  1. Does rural dwellers have adequate knowledge of the proper nutritional intake?
  2. What the extent of prevalence of malnutrition in rural communities?
  3. Does the food choices of rural dwellers contribute to the height of malnutrition in the communities?
  4. What are the factors affecting the food choices in rural communities?

1.5 Research Hypotheses

The following hypothesis will be tested in this study:

  • Ho: The food choices of rural dwellers does not contribute to the height of malnutrition in the communities.
  • Ha: The food choices of rural dwellers contribute to the height of malnutrition in the communities.

1.6 Significance of the Study

The government and the policy makers will borrow from findings of the study to formulate policies that will enhance the proper management of malnutrition in the country especially in the rural areas.

Hospital administrations will gain an understanding from the study on the malnutrition and the factors associated to it in children under five years of age. They will be able to device the ideal ways of improving the management of malnutrition and putting in place a proper nutrition intervention. With the new knowledge, Management boards can make policy recommendation as well as policy implementation possible. It will also help the researcher to advance his knowledge on how to write research on more for future studies, as the researcher will be going for further studies. The findings will be important for other scholars as a point of reference, and they can take up the recommendations of the study as a basis for their research articles.

1.7 Scope of the Study

This study focuses on malnutrition in rural communities and the factors affecting food choice. Specifically, this study focuses on ascertaining whether rural dwellers have adequate knowledge of the proper nutritional intake, determining the extent of prevalence of malnutrition in rural communities, determining whether the food choices of rural dwellers contributes to the height of malnutrition in the communities, and examining the factors affecting the food choices in rural communities.

1.8 Limitations of the Study

In the course of carrying out this study, the researcher experienced some constraints, which included time constraints, financial constraints, language barriers, and the attitude of the respondents. However, the researcher were able to manage these just to ensure the success of this study.

Moreover, the case study method utilized in the study posed some challenges to the investigator including the possibility of biases and poor judgment of issues. However, the investigator relied on respect for the general principles of procedures, justice, fairness, objectivity in observation and recording, and weighing of evidence to overcome the challenges.

1.9 Definition of Terms

Malnutrition:

Is a broad term commonly used as an alternative to under nutrition but technically it also refers to over nutrition. People are malnourished if their diet does not provide adequate calories and protein for growth and maintenance or they are unable to fully utilize the food they eat due to illness (under nutrition). They are also malnourished if they consume too many calories (over nutrition). (UNICEF, 2006).

Nutritional Status:

The condition of the body in those respects influenced by the diet; the levels of nutrients in the body and the ability of those levels to maintain normal metabolic integrity.

Under Nutrition:

Under nutrition denotes insufficient intake of energy and nutrients to meet an individual’s needs to maintain good health. In other words it is a condition where an individual is not getting enough calories, protein, or micronutrients (Young, E.M. 2012).

1.10 Organization of the Studies

The study is categorized into five chapters. The first chapter presents the background of the study, statement of the problem, objective of the study, research questions and hypothesis, the significance of the study, scope/limitations of the study, and definition of terms. The chapter two covers the review of literature with emphasis on conceptual framework, theoretical framework, and empirical review. Likewise, the chapter three which is the research methodology, specifically covers the research design, population of the study, sample size determination, sample size, and selection technique and procedure, research instrument and administration, method of data collection, method of data analysis, validity and reliability of the study, and ethical consideration. The second to last chapter being the chapter four presents the data presentation and analysis, while the last chapter(chapter five) contains the summary, conclusion and recommendation.

Chapter Five

Summary, Conclusions and Recommendations:

5.1 Introduction

This chapter summarizes the findings on malnutrition in rural communities and the factors affecting food choice using Okat community in Onna local government of Akwa Ibom State as a case study. The chapter consists of summary of the study, conclusions, and recommendations.

5.2 Summary of the Study

In this study, our focus was on malnutrition in rural communities and the factors affecting food choice using Okat community in Onna local government of Akwa Ibom State as a case study.The study is was specifically set to ascertain whether rural dwellers have adequate knowledge of the proper nutritional intake, determine the extent of prevalence of malnutrition in rural communities, determine whether the food choices of rural dwellers contributes to the height of malnutrition in the communities, examine the factors affecting the food choices in rural communities.

The study adopted the survey research design and randomly enrolled participants in the study. A total of 141 responses were validated from the enrolled participants where all respondent areresidents in Okat community in Onna local government of Akwa Ibom State.

5.3 Conclusions

In the light of the analysis carried out, the following conclusions were drawn.

  1. Rural dwellers does not have adequate knowledge of the proper nutritional intake.
  2. The extent of prevalence of malnutrition in rural communities is high.
  3. The food choices of rural dwellers contributes to the height of malnutrition in the communities.
  4. The factors affecting the food choices in rural communities includes: poor income status, family background, lack of proper nutritional knowledge, cultural beliefs, inadequate food security.

5.4 Recommendation

The following recommendations were proffered with respect to the findings of the study;

  1. To reduce the present high rate of malnutrition in the rural areas, the study suggests the targeting of women with education programmes and provision of clean water, including the enforcement of healthy environment in the rural areas.
  2. Professional Nutritionist should be made available at least in local government areas so as to sensitize the general public, retrain health practitioners, and make recommendations on the nutritional needs
  3. Electronic media and print should be used for creating awareness regarding the importance of nutrition among rural dwellers.

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Frequently Asked Questions

Does poverty at old age affect nutrition in urban and rural settings?

  • Poverty at old age is associated with poor dietary habit, nutritional status and higher rates of chronic diseases and psychosocial problems. However, there is limited information about this matter according to urban and rural settings.

Why do rural dwellers suffer from high incidence of disease?

  • Besides, they lack other basic infrastructural necessary for the maintenance and promotion of good health. The implication is that rural dwellers are subjected to high incidence of morbidity and mortality resulting from the incidence of preventable and infectious disease.

What are the main causes of low socioeconomic status in rural areas?

  • Lower SES is more prevalent in rural areas. Poor dietary intake, lower fitness and disability were common factors associated with low in SES, regardless of settings.

Is disability associated with nutritional and functional status in rural settings?

  • Disability especially among those with low SES is closely linked with chronic diseases and this may be associated with lack of accessibility to health care resources [ 50 ]. In the present study disability might be associated with poor nutritional and functional status, as has been seen among respondents in rural setting. 

How does poverty affect old age in urban and rural settings?

  • Poverty at old age is associated with poor dietary habit, nutritional status and higher rates of chronic diseases and psychosocial problems. However, there is limited information about this matter according to urban and rural settings.

Does low socioeconomic status attenuate poor nutrition choices of older adults?

  • Low SES attenuated poor nutrition knowledge and purchasing choices of older adults, thus leading to poor dietary pattern with lesser consumption of nutritious food high in fibre especially fresh fruits and vegetables [ 27, 28, 29 ].

How does aging increase the risk of malnutrition in older adults?

  • Aging itself increases risk of malnutrition in older adults due to the simultaneous co-existence of several factors, namely poor oral health, frailty, chronic diseases, physical limitations and psychosocial problems which may gradually deteriorate bodily function [ 8 ].

Does low socioeconomic status affect dietary fibre intake among older people?

  • In our study, low socioeconomic status (SES) is associated with lower intake of dietary fibre among older people residing in both urban and rural areas.

Why are rural residents at higher risk of death from diseases?

  • Several demographic, environmental, economic, and social factors might put rural residents at higher risk of death from these public health conditions. Residents of rural areas in the United States tend to be older and sicker than their urban counterparts. They have higher rates of cigarette smoking, high blood pressure, and obesity.

Why are injuries more common in rural areas?

  • Unintentional injury deaths are approximately 50 percent higher in rural areas than in urban areas, partly due to greater risk of death from motor vehicle crashes and opioid overdoses. In general, residents of rural areas in the United States tend to be older and sicker than their urban counterparts.

Which disease groups have the highest rates of burden in rural areas?

  • Kidney and urinary diseases and injuries were disease groups with particularly higher rates of burden in Remote and very remote areas, compared with Major cities (more than twice as high) (AIHW 2019b). See Burden of disease. People living in rural and remote areas are more likely to die at a younger age than their counterparts in Major cities.

Why are rural Americans at risk for health inequities?

  • Rural Americans—who make up at least 15 to 20%of the U.S. population—face inequities that result in worse health care than that of urban and suburban residents. These rural health disparities are deeply rooted in economic, social, racial, ethnic, geographic, and health workforce factors.

What are the factors associated with low socioeconomic status?

  • Poor dietary intake, lower fitness and disability were common factors associated with low in SES, regardless of settings. Factors associated with low SES identified in both the urban and rural areas in our study may be useful in planning strategies to combat low SES and its related problems among older adults.

What is the socioeconomic status of rural areas?

  • Socioeconomic status in rural areas is gradually improving over a period of time. Many programmes and policies have been implemented to improve the socioeconomic status of population in rural areas. But in economic sense, people of the rural areas could not develop equally over the region.

How does rural poverty affect health care?

  • In 1999, 14.3% of rural Americans lived in poverty compared to 11.2% of urban Americans. 3 Irrespective of where they live, persons with lower incomes and less education are more likely to report unmet health needs, less likely to have health insurance coverage, and less likely to receive preventive health care.

What is the prevalence of low socioeconomic status (SES) among older adults?

  • SES was measured using household income. The prevalence of low SES was higher among older adults in the rural area (50.6%) as compared to the urban area (49.4%).

How does the functional status of the elderly affect nutritional status?

  • Some studies similarly found that not having an income and not receiving regular financial support were associated with poor nutritional status.[12,19,20,21] The functional status of the elderly determines their ability to perform basic self care tasks and live independently, which also includes food intake.

How many people with disabilities live in rural areas?

  • About one-third of adults in rural communities lives with a disability. One in twelve adults in rural counties reports having three or more disabilities.

What is the functional status of the elderly in India?

  • The functional status of the elderly is their ability to carry out their day to day activities including preparation of food and intake, thereby affecting nutritional status. In India, the problem of the health of the elderly is compounded by poor nutrition together with medical issues, including both communicable and noncommunicable diseases.

Is there a scarcity of nutrition consumption among rural households in Bengal?

  • Using a cross-sectional survey, the study aims to understand scarcity of nutrition consumption among rural households in West Bengal. Most of the research related to nutrition and health measured under-nutrition at household using anthropometric outcomes of household members, hence, ignored nutrients based deprivations. 
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