Nutritional Status Of Under-Five Children And Associated Factors

Project and Seminar Material for Nursing (Science)

Nutritional Status Of Under-Five Children And Associated Factors


Abstract


The nutritional status of children under five years is an indicator of nutritional situation in society. Research estimates that risks related to stunting, severe wasting and intrauterine growth retardation are linked to 2.2 million deaths and 21% of disability-adjusted life years worldwide for children under 5 years. Malnutrition in Eastern Nigeria where Ivo Local Government Area is located had high (42%) stunting, (7.3%) wasting and 20% underweight. Considering that Ivo Local Government Area is generally low potential dry zone, this situation could have impacted negatively on nutrition status of vulnerable groups especially children under five years. However, limited data exists to support this.

The nutritional status of one child from each of 144 households were sampled in Ivo Local Government Area was assessed using anthropometric measurements (height/length, weight, MUAC). Data were collected on household demographic and socio-economic characteristics, food production, utilization and food consumption, water and sanitation situation and child characteristics including infant and young child feeding practices (IYCF), immunization and morbidity status using pretested structured questionnaires.

The mean household size was 4.73 ±0.743 and 10% of the households were female headed. The ratio of male to female in the study population was approximately 1: 1.1. The dependency ratio of the population was 1.02. About 90 % of the households in the study population relied on unsafe water supply from unprotected water sources. Only 6.2% and 18.4 % of the households met their energy and protein requirement from the food consumed by the household. Up to 39% of the children were stunted, 7.1% were wasted and 18.1 0% were underweight. These levels were above the national average and high enough to classify the community as chronically foods insecure, according to the FAO/FNSAU integrated food security phase classification of 2006. The prevalence of stunting and wasting was significantly higher in boys than in girls (χ2 =6.765, p =.034) and (χ2= 13.053, p = .036) respectively.

There was significant negative correlation between children’s age and nutritional status based on wasting and underweight (r=-.243, p=0.046 and r=-.296,p=0.007 respectively). Household size was positively and significantly correlated to stunting and wasting (r=.410, p=0.047 and r=.402, p=0.041 respectively). A child who was sick two weeks prior to the survey was more likely to be wasted than a healthy child (Odds Ratio; 1.56, CI: 0.6-5.76).
In conclusion, malnutrition among children under five years in Ivo Local Government Area is indicative of chronic food insecurity situation. Large household size and morbidity experience are important associated factors. Therefore, multisectoral approaches that address different household dynamics including food security, health and nutrition issues at community level should be employed to alleviate malnutrition.


Chapter One


Introduction

1.1 Background to the Study

The difference between food intake and utilization determines the nutritional status of the individual. Change in food consumption and the biological utilization will directly or indirectly reflect in the nutritional status. The nutritional status can be normal, under nutrition or over nutrition. The under and over nutrition are considered as malnutrition. The nutritional status of the under-five might be affected by some factors ranging from busy schedule of the primary care giver to inability to provide enough food and needed health care to maintain normal nutritional status. The determinants of the nutritional status may differ based on regions, communities, or even over time. To proffer necessary recommendations or solve any nutritional problem in an area, it will be important to determine the nutritional status and the underlying causes.

Efforts have been made both nationally and internationally by governmental and non-governmental organizations to maintain normal nutritional status but poor nutrition remains a major link to diseases and reduced life-span. According to Mamulwar, Rathod, Jethani, Dhone, Bakshi, Lanjewar et al. (2014), one quarter of the under-five children are stunted. Many factors have been implicated to influence the nutritional status. Poor diet and disease are considered as immediate factors but there are underlying factors like food security, caring practices of the mother, healthy environment and assessment of health facilities. The underlying causes are also considered to have basic causes which are seen as socio-economic and political conditions (Asegedech, 2014).

Nutritional status of the under-five is of great importance since this period of life is considered as pivotal for adequate growth (Badake, Maina, Mboganie, Muchemi, Kihoro, Chelimo, & Mutea, 2014). Under-nutrition could be described as weighty medical condition characterized by a deficient bodily nutrition (energy, essential proteins, fats, vitamins, and minerals in a diet) as a result of inadequate food intake or faulty assimilation. Over 10 million children of under-five are lost annually due to diseases that can be prevented and even easily treated. Most of these illnesses and majority of these deaths occur in developing countries because of the poor economy of such Countries (Black, Morris & Bryce, 2003). Malnutrition cause more over 30% of all children’s deaths who are under-five(United Nations Children’s Fund (UNICEF), 2009). According to Badake, Maina, Mboganie, Muchemi, Kihoro, Chelimo and Mutea, (2014), assessing the growth of children is a good parameter to look at the development of the children and this also gives insight about food security in the area and assess to good health services.

Poor nutritional status has called for different programmes and interventions in different sectors in order to improve the nutrition status. Sequel to this, experts from different fields are strategizing and evaluating various interventions that have nutrition components (Macias & Glasauer, 2014). Assessing nutritional status is the easiest indicators for assessing the impact of interventions that are nutrition focused and this can be done using various methods. Assessing nutritional status entails a deep understanding of what people consume and the determinants of people’s nutritional habits. The nutritional status can then be traced to have a myriad of determinants.

Different factors have been implicated to affect the nutritional status of the under-five and there are repeated episodes of diseases that are often seen among these children. Some of the factors include inadequate food availability, poor caring capacity of the caregiver, lack of basic education, poor health systems, poor housing and environmental conditions. Communities that are unable to satisfy the basic needs of its citizens are likely to generate more individuals with poor anthropometric indices.

Several strategies have been put in place to maintain adequate nutritional status of the children (e.g. exclusive breastfeeding). 17% has been found to be the exclusive breastfeeding rate in Nigeria and it has also been documented that 21% of mortality among the under-five can be traced to breastfeeding patterns that do not follow the set standard (Ojofeitimi, 2016). Adequate diet and health care during first few years of life is fundamental for child’s development and this help to maintain adequate or normal nutritional status. Early in life, irreversible drop in linear growth and psychological impairment can occur when there is problem with food consumption or utilization (Alamu, Atawodi & Edokpayi, 2011). Growth is most rapid in the early years of life and this may not be comparable to any other time after birth. Since good nutrition has been identified to play a pivot role in growth particularly in the early years of life, it is important to assess the nutritional status of the under-five and the associated determining factors.

The need for food by mankind most especially the growing up children has been emphasized over the years (Adegun, Ajayi-Vincent, & Alebiosu, 2013). The nutritional status is solely dependent on the adequate and right consumption of nutrients from foods and the body’s ability to make use of them adequately to meet its metabolic needs of health and fitness. At early stage of growth, several biochemical activities that affect growth and development are going on in the body and these require nutrition. When there are inadequate nutrients available for these activities then there is likelihood of developing stunted growth and development (Adegun, Ajayi-Vincent, & Alebiosu, 2013).

To find solutions to the nutritional related problems that are common in the early stage of life, it is very necessary to determine the nature, magnitude and determinants of malnutrition. Anthropometric measurements are accepted widely as key indicator of the nutrition status of the community. Anthropometric indices are also suggestive of the socio-economic level. The anthropometric measurements include measurement of weight for age, height for age, weight for height and measurement of mid-upper arm circumference (MUAC). The integrated management of childhood illness (IMCI) approach for the classification of nutritional status will be used in this study.

According to Hunger Facts (2015), globally about 795 million individuals are undernourished. The vast majority (98%) of these undernourished reside in the developing countries. Under-nutrition among the under-five remains a problem faced by different parts of the world. Close to 50% of all deaths among under-five are attributable to under nutrition. This implies that there is unnecessary loss of about 3 million young lives every year (Hunger Facts, 2015). In Sub-Saharan Africa, close to 50% of children particularly the under-five are malnourished and deaths from such nutrition related condition is on the increase (FAO, 2008). Nutrition related problem in Sub-Saharan Africa has added more to the burden of childhood morbidity and mortality. However, the information available on the nutritional status of the under-five in informal settlements can be considered as little and inadequate (Olack, Burke, Cosmas, Bamrah, Dooling, Feikin & Breiman, 2011)

Reducing nutritional related problems among children particularly the under-five is a huge challenge that is being faced by different countries particularly the underdeveloped and the developing countries. In Kenya, the percentage of stunted children among the under-five is 35%, 14% were considered to be severely stunted while underweight was 16% (low weight-for age) and severely underweight was 4%. The core factor responsible for all these nutrition related health challenges as conceived by different researchers can be linked to food access issue, infections of various degrees and forms, maternal/paternal factor, socio-economic factors and other related factors.

Nigeria (especially the rural areas) is one of the developing countries that are affected by this nutrition-related problem. This might be related to causes that are found in other regions of the world like poor access to food, primary care giver factor, socio-economic factor, area of abode and other related factors. The Nigeria Demographic and Health Survey (2003) put the rate of stunted growth among the under-five years to be 38%, underweight to be 29% while wasting was 9.2%. Several factors can be considered to have caused these nutritional deficiencies. According to the Federal Ministry of Health (FMOH) Nigeria (2007), 7% is the rate of compliance of mothers to exclusive breastfeeding of their children who are less than 6 months.


1.2 Statement of the Problem

According to NAFDAC, about 2.2 million people in Nigeria were classified in either the Crisis or Stressed Phases of food insecurity. Ivo local government area was classified in the Stressed Phase. The greatest impact of food insecurity is normally observed in children who are the most nutritionally vulnerable group of the population.

Malnutrition observed in children under five years in Eastern region where Ivo LGA is located is high, estimated at 41.9% stunting, 7.3% wasting and 19.8 % underweight. According to WHO classification (FSAU, 2005), these level are unacceptably high. Considering that the Area is generally low potential dry zone, this situation could have impacted negatively on nutrition status of vulnerable groups especially children under five years. However limited data exists to support this. Therefore, this study sought to determine nutritional status of children under five years and associated factors in Ivo Local Government Area of Ebonyi state for informed appropriate action to mitigate the high levels of malnutrition in the region.


1.3 Objective of the Study

The main objective of the study was to determine nutritional status of children under five years and associated factors in Ivo Local Government Area.

Specific objectives of the studies included:-

  1. To determine demographic, socio-economic characteristics, food production and utilization of households in Ivo Local Government Area
  2. To determine the nutritional status of children under five years in the study area
  3. To determine infant and young child feeding (IYCF) practices for children (0-24 months old) in Ivo Local Government Area.
  4. To determine immunization (12-35 months) and morbidity status of children under five years in Ivo Local Government Area.

1.4 Hypotheses of the Study

  • Ho1: There is no significant association between demographic, socio-economic factors, household food production and utilization and nutritional status of children under five years in Ivo Local Government Area.
  • Ho2: There is no significant association between Infant and Young Child Feeding (IYCF) practices and nutritional status of children aged 0-24 months in Ivo Local Government Area.

1.5 Research Questions

The following research questions will be answered by the study

  1. What is the demographic, socio-economic characteristics, food production and utilization of households in Ivo Local Government Area?
  2. What is the nutritional status of children under five years in the study area?
  3. What is the infant and young child feeding (IYCF) practices for children (0-24 months old) in Ivo Local Government Area ?
  4. What is the immunization (12-35 months) and morbidity status of children under five years in Ivo Local Government Area ?

1.6 Significance of the Study

Several studies have shown that several factors are associated with nutritional status of children under five years. However, among the studies that have been conducted so far, the factors associated with malnutrition differ within countries or even regions around the world. Ivo Local Government Area has its own special characteristics in terms of socio-economic, water and sanitation, food security and feeding practices but data on how these factors impact on nutrition status of children is scanty.


1.7 Scope / Limitation of the Study

The study will explore the socio-economic, water and sanitation, food security and feeding practices and how these factors impact on nutrition status of children in Ivo Local government Area of Ebonyi state Nigeria.


Chapter Five


Conclusion and Recommendation

5.1 Conclusion

The study established that malnutrition is high among children under five years, with risk being highest among those who were between the ages of 12-36 months of life. These high levels qualify the area to be classified as chronic food insecure area. The high self-reported level of exclusive breast feeding does not translate into improved nutritional status in older children.

There is high morbidity experience, generally due to poor sanitation and high incidence of use of unsafe water in the area. Food production among the study household is inadequate, due to farming on small pieces of land (2 acres) and low rainfall, limit their capacity to produce enough food. Diet diversity is poor comprising mainly starchy food followed by legumes. Households depend on market supply for their vegetable and fruits and therefore ability to acquire them entirely depends on purchasing power. Therefore, malnutrition among children under five years in Ivo Local Government Area is indicative of chronic food insecurity situation. Large households size and morbidity experience are important associated factors.


5.2 Recommendation

Since most households complement their diet largely by purchased food, the types and the amount of food purchased for consumption and their contribution to the family dietary requirement need to be established. There is also need to explore the seasonality changes in energy and protein availability from farm produce and food purchase to get real food security situation in the area.

The problem of food insecurity could be tackled through multisectoral approaches that address different household dynamics including food security, health, nutrition and water/sanitation. Agricultural projects should therefore integrate health and nutrition components during planning to develop focused interventions aimed at improving nutrition, health and food security of the households. It is therefore recommended that the planned project/programme for Ivo Local Government Area should make provision for such integration and collaboration with the relevant sectors including health and water. Provision of nutritional education to the community members is also essential to address malnutrition.


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