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 (Tette, Sifah & Nartey, 2015). 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.

According to Adegun, Ajayi-Vincent, and Alebiosu (2013) there are not enough supporting data on under-nutrition among children in schools in Ekiti State which can easily be generalized but a closer look at the children in schools by different investigators suggests the prevalence of nutritional related problems among children in Ekiti. Common nutritional problems as faced by the under-five made are protein energy malnutrition (PEM), anemia due to iron deficiency, vitamin A and iodine deficiency respectively (Babatunde, 2003).

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 under-five children 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 under-five children 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 under-five children, 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, Ado-Ekiti.

1.3 Objective of the Study

The main objective of this study is to assess nutritional status of the under-five children and find out the associated factors in Okeyinmi Comprehensive Health Centre, Ado-Ekiti. The specific objectives are to:

1. assess nutritional status of the under-five children using anthropometric measurements in Okeyinmi Comprehensive Health Centre, Ado-Ekiti;
2. find out the level of awareness of mothers about nutritional status of the under-five children;
3. assess the factors that influence the nutritional status of the under-five children and
4. find out the feeding practices engaged in by mothers of under-five children.

1.4 Research Questions

1. What is the nutritional status of the under-five children using anthropometric measurement in Okeyinmi Comprehensive Health Centre, Ado-Ekiti?
2. What is the level of awareness of mothers about nutritional status of the under-five children?
3. What are the factors that influence the nutrition status of under-five children?
4. What are the feeding practices engaged in by mothers of under-five children?

1.5 Hypotheses

H_01: There is no significant relationship between the nutritional status of the under-five and the    

        socio-economic factor of the primary care giver.

H_02: There is no significant difference between male and female under-five nutritional status.

H_03: 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 under-five children between the ages of 6months and 59months attending Infant welfare clinic of Okeyinmi Comprehensive health centre, Ado-Ekiti. 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 under-five children.

1.8 Operational Definition of Terms

1. Nutritional status: This is the health status of the under-five children as determined by anthropometric measurement.
2. Associated factors: These are the determinants of the nutritional status of the under-five in Okeyinmi Comprehensive Health Centre, Ado-Ekiti.
3. Under-five children: These are children whose ages range from 6months to 59months and are brought to the Okeyinmi Comprehensive Health Centre, Ado-Ekiti.
4. Anthropometric measurements: These are standard measurements to determine the nutritional status. This includes measurement of weight for age (to determine underweight), height for age (to determine stunting), weight for height (to determine wasting).
5. Primary care giver: This is anybody that brings the under-five child to the infant welfare clinic of Okeyinmi Comprehensive Health Centre, Ado-Ekiti. The primary care givers included the mothers, fathers, or guardians.