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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.