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1.1 BACKGROUND INFORMATION
Nutrition is the sum total of the processes involved in the intake and utilization of food substances by living organisms, including ingestion, digestion, absorption, transport and metabolism of nutrients found in food.(Melvin, 2005).
Adequate nutrition during early childhood is fundamental to the development of each child’s potential. It is established that the period from birth to two years of age is a “critical window” for the promotion of optimal growth, health and overall survival of children (Ali, et al 2006).
Good food is important for good health. Children who are well fed during the first two years of life are more likely to stay healthy for the rest of their childhood. During the first six months of a child’s life, breast milk alone is the ideal food. It contains all the nutrients needed for healthy growth as well as immune factors that protect against common childhood infections (Ashworth, 2002).
Good nutrition is the cornerstone for survival, health and development for current and succeeding generations. Well-nourished children perform better in school, grow into healthy adults and in turn give their children a better start in life (UNICEF, 2006). The United Nations Children’s Fund (UNICEF) and the Ministry of Health (MoH), Nigeria recommend exclusive breastfeeding for the first six months of the infant’s life. Children between the ages of six months and four years who do not get enough of the right types of food to eat easily become malnourished
According to UNICEF (2006), each year under-nutrition contributes to the deaths of about 5.6 million children under- 5 in the developing world and 146 million children younger than 5 are underweight and at increased risk of early death, illness, disability, and underachievement. UNICEF reports that, in the least developed countries, 42% of children are stunted and 36% are underweight as a result of poor nutrition or under
The World Health Organization (WHO) refers to malnutrition as “Failure of cells to perform their physical functions due to inability to receive and use the energy and nutrients needed in terms of amount, mix and timeliness. Waterlow and Insel (1995) described malnutrition as “Failing Health that results from long standing faulty nutrition that either fails to meet or greatly exceeds nutritional needs. This description could mean inappropriateness of the food taken. Again, Harrison and Waterlow (1990) defined malnutrition as “The effects of any nutrient deficiency including energy, protein and micronutrients.”
Malnutrition can be operationally defined as a lack of essential nutrients or failure to use available foods to best advantage (Barasi, 1997). Malnutrition affects physical growth, morbidity, mortality, cognitive development, reproduction and physical work capacity and it consequently impacts on human performance, health and survival. A well- nourished child is one whose weight and height measurements compare very well with the standard normal distribution of heights and weighs of healthy children of the same age and sex (Salah, 2006).
In this perspective, malnutrition is not less food or food without the needed nutrients present. It is rather the failure of cells to perform their physiological functions due to inability to receive and use the nutrients in the right proportion.
Malnutrition especially among young children is a widespread problem in most developing countries. Over one hundred million children less than five years of age suffer from protein-energy malnutrition and more than ten million of them suffer from severe protein energy malnutrition, which is usually fatal if untreated (WHO, 1981). Malnutrition refers to disorder resulting from an inadequate diet or failure to absorb or assimilate dietary elements (Jackson, 1975).
Malnutrition may involve undernutrition and include the symptoms of deficiency diseases or it may be due to overnutrition arising from excessive intake of nutrients (Barasi, 1997). In the case of children under two years they suffer mostly from undernutrition specifically, protein-energy malnutrition. The African Region has the highest estimated prevalence of stunting (48.1%) and has the lowest rate of improvement (20%) (Vlok, 1991). Under-nutrition and under-nourishment also refer to a condition where there is insufficient intake of food to cover energy and nutrient needs. Insufficient intake of food that results in malnutrition could be attributed to varied reasons (Morley and Woodland 1992).
Under-nourished children have lowered resistance to infection; they are more likely to die from common childhood ailments like diarrhoeal diseases and respiratory infections, and for those who survive, frequent illness saps their nutritional status, locking them into a vicious cycle of recurring sickness and faltering growth. Their plight is largely invisible; three quarters of the children who die from causes related to malnutrition were only mildly or moderately undernourished, showing no outward sign of their vulnerability (UNICEF, 2006).
In Asia, the prevalence of stunting (32.8-43.7%) is high, particularly in south and central Asia, although rates of stunting continue to improve throughout this region. In a review of mortality and morbidity trends in Bangladesh between 1970 and 1975 by Hussain (1987) it was found that the crude mortality rate, the infant mortality and the childhood malnutrition rate fell and rose with improvement and deteriorations in food supply that were largely determined by political, economic, climate and social factors.
The importance of addressing childhood malnutrition is a prerequisite for achieving internationally agreed goals to reduce malnutrition and child mortality. Child growth is therefore internationally recognized as an important public health indicator hence growth monitory centers are established in all State.
In Nigeria malnutrition rate among children under-two years recorded 2.7% in 2003, 5.4% in 2004, and 7.5% in 2005 (GHS, 2005). The Nigeria Health Service Nutrition unit collaborates with the WFP in executing a food supplementation programme in five regions of the country where malnutrition rates are considered especially acute. The five regions are Central, Brong-Ahafo, Northern, Upper East and Upper West Regions. Under this programme food rations are distributed to pregnant and lactating women as well as children 1-3 years of age at the feeding centres in selected State during periods of the year when food is particularly scarce. Centre attendants who have been trained to conduct growth monitoring also educate mothers on basic nutrition and hygiene.
The Millennium Development Goal 4 (MDG 4) is aimed at ensuring child survival and a reduction in malnutrition among children under five by at least one third and to reduce mortality by 2/3 by the year 2015 with special attention to children less than two years of age. (UNICEF, 2006)
Children who are malnourished are much more susceptible to life-threatening diseases such as malaria, pneumonia and diarrhoea infections.
Complications from malnutrition are;
• Anemia in children
• Poor mental or cognitive development
STATEMENT OF PROBLEM
Malnutrition situation in Nigeria is a serious public health problem among pre-school children. About 3 out of every 10 young children are undernourished. Nearly 2 out of every 10 babies born die before their 5th birth day. Undernutrition is an important cause of death (MoH 1995)
According to the Reproductive and Child Health (RCH) annual report, (2005) among children registered at Child Welfare Clinics, malnutrition rates have been increasing over the years. In children 0-11months, about 4.1% of children were found to be malnourished. This shows an increase when compared with 2.6% in 2004.Among children 12-23 months, 7.5% were malnourished as compared to 5.4 in 2004.
The 1998 Nigeria Demographic and Health Survey (GDHS) shows that under-nutrition is significant in Nigeria with one in four Nigerian children less than five years of age being stunted (short for their age) 10 % wasted and 25% under weight. The Survey revealed that, in general children residing in the three northern-most regions of Nigeria (Northern, Upper West and Upper East Regions) and children of uneducated mothers are more likely to be malnourished.
1. There is no difference in disease conditions among the children in the two State.
2. There is no difference in the level of knowledge of mothers in adequate nutrition in the two State.
3. There is no difference between the nutritional status of children under-2 years in Akwa Ibom State and Cross River State State
1.5. RESEARCH QUESTIONS
• What is the difference in the cultural factors towards complimentary feeding in the two State?
• Is there a difference in socio-economic status of parents of these children in the two State?
• What is the difference in disease conditions affecting children in the two State?
• What is the difference in level of knowledge related to mothers’ knowledge in adequate nutrition in the two State?
• Is there a difference in nutritional status of children under-2 years in the two State?
To compare the nutritional status of children under two years in Akwa Ibom State with those in Cross River State.
1. To determine whether there is a difference in cultural taboos related to complimentary foods in the two State.
2. To determine the difference in socio-economic status of parents of these children in the two State
3. To identify the difference in diseases affecting children in the two State.
4. To compare the level of knowledge of mothers in child nutrition
5. To measure using anthropometric indicators the nutritional status of children under-two in Akwa Ibom State and Cross River State respectively.
6. To make recommendations to programme implementers with the view to improve the programme implementation
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