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CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
Children between the ages of birth and one year are considered infants. Infants grow very rapidly and have special nutritional requirements that are different from other age groups. Infant nutrition is designed to meet the special needs of every young children and give them a healthy start in life. Children under one year old do not have fully mature organ systems. They need nutrition that is easy to digest and contains enough calories, vitamins, minerals, and other nutrients to grow and develop normally. Infants also need the proper amount of fluids for their immature kidney’s to process. In addition, infant nutrition involves avoiding exposing infants to substances that are harmful to their growth and development.
Infancy is a time of incredibly rapid growth and development. Getting the right kinds of nutrients in the right quantities and avoiding the wrong kinds of substances gives infants the best chance at a healthy start to life. Parents are responsible for seeing that their infant’s nutritional needs are met.
Good nutrition is essential to the rapid growth and development that occurs during a baby’s first year. Providing babies with the right foods will promote good health and give them the opportunity to enjoy new tastes and textures as they establish good eating habits. Also, feeding can help babies establish warm relationships with their parents and caregivers. Positive and supportive feeding techniques are essential in allowing babies to eat well and to develop healthy attitudes toward themselves and others.
During the first year, babies’ mouths develop from being able only to suck and swallow to being able to chew. Their digestive tracts mature from being able to take in only liquids, such as breastmilk or formula, to being able to receive a wide variety of foods. And at the same time, they progress from needing to be fed toward feeding themselves. As babies continually mature, their food and feeding patterns must continue to change.
Choosing how to feed your baby is an important decision that has lifelong effects for your baby and for you. What you have seen and learned about infant feeding from your family, friends and teachers is likely to influence your attitude and perceptions.
Whether you definitely plan to breastfeed or you are still uncertain, consider the fact that your milk is the best milk for your baby, and it is the ideal first food for your baby’s first several months.
Nature designed human milk especially for human babies, and it has several advantages over any substitute ever developed. Breast milk contains just the right balance of nutrients, and it contains them in a form most easily used by the human baby’s immature body systems. Because it was developed for the human baby, breast milk is also the most gentle on your baby’s systems.
Exclusively breast-fed infants should be supplemented with vitamin D within the first few days of life. Consult your infant’s physician regarding supplementation.
If you decide not to breastfeed, or are unable to breastfeed, commercial iron-fortified formulas can provide adequate nutrition for your infant. Infant formulas contain adequate amounts of protein, calories, fat, vitamins and minerals for growth. However, formula does not contain the immune factors that are in breast milk. The immune factors that are found in breast milk can help prevent infections.
Africa is surprisingly the fastest growing continent on the planet despite its tribulations of poverty, civil wars, drought, famine and the devastating impact of HIV and AIDS. This is largely due to the high fertility rates in the Sub Saharan region where population is expected to double by mid century as estimated by the United Nations World Population Prospects. Despite the large numbers of children born in Africa, their survival rate is crippled by the inadequate neonatal services, risk of infection from communicable diseases and compounding impact of malnutrition. While infant mortality has decreased significantly across the world current data shows that it remains highest in Sub Saharan Africa which accounts for almost half of all infant mortalities with a rate of 98/1000 live births. Various interventions have been introduced in an attempt to meet the millennium development goal of decreasing infant mortality by two thirds by the year 2015. A key invention point is to decrease malnutrition which associated with 45% of deaths in this age group as reported by the United Nations Interagency Group for Child Mortality Estimation in the 2013 report.
A number of factors have been identified as barriers to appropriate Infant and Young Child Feeding which recommends initiation of breast feeding within one hour of delivery, exclusive breast feeding for the first 6 months of life followed by the introduction of appropriate complementary foods and continuation of breast feeding until 2 years of age and beyond. This ambitious but difficult to implement strategy was endorsed by the World Health Assembly in May 2002.
The immediate cause of malnutrition is inadequate intake and absorption of nutrients. This is influenced by a range of underlying factors, such as access to the right foods, education levels and sanitation. Many of these causes are relatively well understood with evidence based solutions which address them, including targeted food fortification programs for example. But these causes cannot account for all types of malnutrition. Child feeding behavior is frequently being addressed in many debates about malnutrition in international development both as a cause and a potential solution to the problem. Breastfeeding promotion was ranked as one of the most cost effective interventions by the Copenhagen Consensus in both 2008 and 2012. Yet changing child feeding behaviour is one of the most difficult interventions to implement. This is due to the fact that food, diets and behaviour are deeply cultural; how we eat, what we eat and when we eat are all determined by practices, ideas and behavior’s instilled since birth. Infant feeding practices are not just based on rational decisions but rooted in existing cultural norms, emotional connections with food and nutrition, and subconscious motives
Reduction in malnutrition rates is imperative if the battle to achieve MDG 4 is to be won. Many factors are responsible for the high level of malnutrition in Sub Saharan Africa. Understanding the factors behind poor infant and child feeding practices will assist in addressing these issues and ensure that the battle for child survival in the fastest growing population globally will not be lost.
Whereas well intended nutrition policies and guidelines exist there to be a much higher level of political pressure, social and community mobilization to realize increased uptake and acceptance and uptake in Sub-Saharan countries.
Factors including biologic, economic, cultural, environmental and of disease origin have been found to affect nutritional status. Inadequate food intake, food insecurity, poor distribution of food in the household, poor storage pattern of the available food, wrong food handling, nutritional taboos/ harmful traditional practices and different types of infections among infants might make the children to be most vulnerable to nutritional related problems. These factors might be seen to have immediate, underlying biological and behavioural, underlying social and economic, and basic influences on the children (Degarege, Degarege & Animut, 2015). Understanding the causes and the effects of different nutritional status will help proffer necessary recommendations.
1.2 Statement of the Problem
Nutrition related problems affect the populace but the under-five and women are most susceptible to this condition. The unique physiology of the under-five, socioeconomic factor, and other related factors in the society might be implicated. Available data shows that more than 2billion individuals are affected with different degrees of nutritional related problems. Children that are up to 2.6million die yearly following nutrition related problem. This accounts for about one third of children’s deaths globally. Stunted children are highest in number in Nigeria which makes Nigeria to have the highest stunted rate in Africa and third globally having above 10 million citizens who are stunted. Within the first 1,000days of life, malnutrition accounts for over one-third of deaths among the under-five years and half of all child deaths worldwide (Malnutrition and Child Survival in Nigeria, 2016).
North-Eastern and North-Western parts of Nigeria where most of the food consumed in Nigeria are cultivated have the increased number of cases of nutritional deficiencies as compared to other zones (Nigeria Demographic and Health Survey, 2016). This depicts that food production does not translate to food consumption. Several infants would have developed micronutrient deficiencies before they reach the age of 2years to the extent that their growth and development become impaired. Children from families living below the poverty line have been proven to be at risk of malnutrition four times more than people living above the poverty line. The children from homes that are not poor too can be malnourished when the food intake is not adequately and well combined. Food insecurity has been found to be closely linked to hunger and malnutrition. 39% of people living in Nigeria are considered to be living below the poverty live.
The North-East and North-Western zones of Nigeria have witnessed a lot of insurgents and the Niger Delta region too has been troubled by militancy acts. These acts transform to the increase in malnutrition rate among citizens in Nigerian because farming activities are hindered in these regions. This is often clearly seen among the internally displaced persons (IDP) living in IDP camps in the North-Eastern and North Western zones of Nigeria. People are now confined to the IDP camps where they are made to struggle for little rations of food available for consumption. Farming activities/ food production becomes completely paralyzed. The largest percentage of people that bear these burdens are the infants, women and the elderly.
There are also cases of food availability but inability of the illiterate parents and caregivers to combine the food sources correctly and give adequate diet to the under-five still bring about malnutrition. Harmful traditional practices in the community can also affect the nutritional status of the under-five and that of the family as a whole which then translate to that of the entire nation. The intellectual development of the child is at stake when there is poor nutritional intake (UNICEF, 2016).
Managing the incessant illnesses of children places economic burden on the family and government because the money spent on these nutritional-related diseases (which would have been prevented) could be used for other developmental projects (Kitinya, 2013). Poor school performance and lower productivity could also be the impact of poor nutritional status on the society. As a result of the magnitude of the identified problem, the researcher is set to assess the major determinants of nutritional status among under-five in Comprehensive Health Centre, Kaduna.
1.3 Objective of the Study
The main objective of this study is to assess nutritional status of the infants and find out the associated factors in Kawo General Hospital, Kaduna. The specific objectives are to:
- assess nutritional status of the infants using anthropometric measurements in Kawo General Hospital, Kaduna;
- find out the level of awareness of mothers about nutritional status of the infants;
- assess the factors that influence the nutritional status of the infants and
- find out the feeding practices engaged in by mothers of infants.
1.4 Research Questions
- What is the nutritional status of the infants using anthropometric measurement in Kawo General Hospital, Kaduna?
- What is the level of awareness of mothers about nutritional status of the infants?
- What are the factors that influence the nutrition status of infants?
- What are the feeding practices engaged in by mothers of infants?
1.5 Hypotheses
H01: There is no significant relationship between the nutritional status of the under-five and the
socio-economic factor of the primary care giver.
H02: There is no significant difference between male and female under-five nutritional status.
H03: There is no significant association between nutritional status and the age group of the child.
1.6 Scope of the Study
The study was delimited to infants between the ages of 6months and 59months attending Infant welfare clinic of Kawo General Hospital, Kaduna. The study used anthropometric measurement only as the method of determining the nutritional status of the child. The researcher delimited the study to only 6months to 59months children because the MUAC tape/ Shakir’s tape is usually used for children of this age group.
1.7 Significance of the Study
Findings from this study provided data which reflects the nutritional status of the under-five and this would help in decision or policy making process. This study would help in early recognition of nutritional related problems of the under-five which would allow the mothers of children with good nutritional status to be praised and mothers with children with poor nutritional status to be adequately counseled. Findings would also show the pattern/prevalence of nutritional related problems among the under-five as revealed by anthropometric measurement. Findings from this study would serve as relevant and reference materials in the area of nutrition of the under-five by adding to the body of existing knowledge. Recommendations from this work would serve as assistant to the governments in making policies that might reduce the burdens of nutrition related problems in the society especially among the infants.